International Ophthalmology

, Volume 30, Issue 2, pp 221–227 | Cite as

Sympathetic ophthalmia following vitreoretinal surgery

  • Zeynep Ozbek
  • Gul Arikan
  • Aylin Yaman
  • Hakan Oner
  • Meltem Soylev Bajin
  • A. Osman Saatci
Case Report

Abstract

The objective is to discuss the characteristics of three patients who developed sympathetic ophthalmia following vitreoretinal surgery. The first case was a 29-year-old man who underwent placement of an encircling band, pars plana vitrectomy, foreign body removal, endolaser photocoagulation, transscleral cryotherapy, and silicone oil injection due to a retained foreign body 3 months after a corneoscleral rupture repair. He experienced visual loss in the fellow eye 2 months after the vitrectomy. An extensive exudative detachment was detected in the fellow eye. Sympathetic ophthalmia was diagnosed and systemic steroids together with azathioprine were initiated. The injured eye was enucleated as there was no useful vision. The other two cases were operated for rhegmatogenous retinal detachments. One underwent placement of an encircling band, pars plana vitrectomy, silicone oil injection, and endolaser photocoagulation with good anatomic outcome. However, 4 months later, the fellow eye experienced severe visual loss with disc swelling and hyperemia and exudative retinal detachment. Systemic steroid was sufficient to reverse the process and the visual acuity recovered. The other case underwent placement of an encircling band, subretinal fluid drainage, SF6 injection and 360° indirect laser photocoagulation. Two years later, he noted a sudden visual decrease in the fellow eye in which we detected a Harada-like extensive exudative detachment. Systemic steroid without immunosuppressive therapy rendered regression of the detachment and recovery of good visual acuity. Sympathetic ophthalmia may occur following vitreoretinal surgery either for trauma-related problems or rhegmatogenous retinal detachment. Since it may present with relatively mild anterior segment findings and mainly posterior segment involvement; any visual disturbance in the fellow eye of a patient with a history of perforating trauma or vitreoretinal surgery should be thoroughly evaluated for sympathetic ophthalmia.

Keywords

Ocular perforating trauma Sympathetic ophthalmia Vitreoretinal surgery 

References

  1. 1.
    Mackenzie W (1830) A practical treatise on diseases of the eye, 3rd edn. Longmans, London (quoted in: Duke-Elder WS, Perkins ES (1996) Diseases of the uveal tract. In: Duke-Elder WS (ed) System of ophthalmology, Vol. IX. C.V. Mosby, St Louis, pp 285–292)Google Scholar
  2. 2.
    Bilyk JR (2000) Enucleation, evisceration, and sympathetic ophthalmia. Curr Opin Ophthalmol 11:372–386. doi:10.1097/00055735-200010000-00015 CrossRefPubMedGoogle Scholar
  3. 3.
    Damico FM, Kiss S, Young LH (2005) Sympathetic ophthalmia. Semin Ophthalmol 20:191–197. doi:10.1080/08820530500232100 (Review)CrossRefPubMedGoogle Scholar
  4. 4.
    Chan CC, Benezra D, Rodrigues MM, Palestine AG, Hsu SM, Murphree AL, Nussenblatt RB (1985) Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia. Ophthalmology 92:580–590PubMedGoogle Scholar
  5. 5.
    Chan CC, Nussenblatt RB, Fujikawa LS et al (1986) Sympathetic ophthalmia; immunopathologic findings. Ophthalmology 93:690–695PubMedGoogle Scholar
  6. 6.
    Kilmartin DJ, Dick AD, Forrester JV (2000) Prospective surveillance of sympathetic ophthalmia in the UK and Republic of Ireland. Br J Ophthalmol 84:259–263. doi:10.1136/bjo.84.3.259 CrossRefPubMedGoogle Scholar
  7. 7.
    Makley TA Jr, Azar A (1978) Sympathetic ophthalmia. A long-term follow-up. Arch Ophthalmol 96:257–262PubMedGoogle Scholar
  8. 8.
    Marak GE Jr (1979) Recent advances in sympathetic ophthalmia. Surv Ophthalmol 24:141–156. doi:10.1016/0039-6257(79)90018-3 (Review)CrossRefPubMedGoogle Scholar
  9. 9.
    Albert DM, Diaz-Rohena R (1989) A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol 34:1–14. doi:10.1016/0039-6257(89)90125-2 (Review)CrossRefPubMedGoogle Scholar
  10. 10.
    Liddy L, Stuart J (1972) Sympathetic ophthalmia in Canada. Can J Ophthalmol 7:157–159PubMedGoogle Scholar
  11. 11.
    Bechrakis NE, Müller-Stolzenburg NW, Helbig H, Foerster MH (1994) Sympathetic ophthalmia following laser cyclocoagulation. Arch Ophthalmol 112:80–84PubMedGoogle Scholar
  12. 12.
    Margo CE, Pautler SE (1990) Granulomatous uveitis after treatment of a choroidal melanoma with proton-beam irradiation. Retina 10:140. doi:10.1097/00006982-199004000-00010 CrossRefPubMedGoogle Scholar
  13. 13.
    Wang WJ (1983) Clinical and histopathological report of sympathetic ophthalmia after retinal detachment surgery. Br J Ophthalmol 67:150–152. doi:10.1136/bjo.67.3.150 CrossRefPubMedGoogle Scholar
  14. 14.
    Lyons C, Tuft S, Lightman S (1997) Sympathetic ophthalmia from inadvertent ocular perforation during conventional retinal detachment surgery. Br J Ophthalmol 81:612. doi:10.1136/bjo.81.7.e608 CrossRefPubMedGoogle Scholar
  15. 15.
    Gass JD (1982) Sympathetic ophthalmia following vitrectomy. Am J Ophthalmol 93:552PubMedGoogle Scholar
  16. 16.
    Kilmartin DJ, Dick AD, Forrester JV (2000) Sympathetic ophthalmia risk following vitrectomy: should we counsel patients? Br J Ophthalmol 84:448–449. doi:10.1136/bjo.84.5.448 CrossRefPubMedGoogle Scholar
  17. 17.
    Abu El-Asrar AM, Al Kuraya H, Al-Ghamdi A (2006) Sympathetic ophthalmia after successful retinal reattachment surgery with vitrectomy. Eur J Ophthalmol 16:891–894PubMedGoogle Scholar
  18. 18.
    Pollack AL, McDonald HR, Ai E, Green WR, Halpern LS, Jampol LM, Leahy JM, Johnson RN, Spencer WH, Stern WH, Weinberg DV, Werner JC, Williams GA (2001) Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent penetrating trauma. Retina 21:146–154. doi:10.1097/00006982-200104000-00008 CrossRefPubMedGoogle Scholar
  19. 19.
    Gupta V, Gupta A, Dogra MR (2007) Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India. Eye 22:1459–1464. doi:10.1038/sj.eye.6702927 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Zeynep Ozbek
    • 1
  • Gul Arikan
    • 1
  • Aylin Yaman
    • 1
  • Hakan Oner
    • 1
  • Meltem Soylev Bajin
    • 1
  • A. Osman Saatci
    • 1
  1. 1.Department of OphthalmologyDokuz Eylul University School of MedicineIzmirTurkey

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