Pediatric Sympathetic Ophthalmia: 20 Years of Data From a Tertiary Eye Center in India

Abstract

Purpose: To examine the clinical profile of sympathetic ophthalmia among the pediatric age group. Methods: Retrospective review of patients 18 years and younger with sympathetic ophthalmia seen in a tertiary eye care center between 1997 and 2017. Results: Of 20 patients included in the study, 70% were male. The most common inciting event for sympathetic ophthalmia was trauma (85%), followed by vitreoretinal surgery (15%). All patients were treated with systemic steroids. Seventeen patients received additional corticosteroid-sparing immunosuppressive agents, and 4 patients (20%) required more than one immunosuppressive agent. Azathioprine was the most commonly used corticosteroid-sparing immunosuppressive agent. The most common complications were cataract (50%) and ocular hypertension (30%). The mean presenting best corrected visual acuity in the sympathizing eye was 1.15 ± 0.99 logarithm of the minimum angle of resolution (logMAR), which improved to 0.54 ± 1.00 logMAR following treatment. Visual outcome was good (6/12 or better) in 70% of the sympathizing eyes, and 3 of the exciting eyes in the current study had good visual outcomes after the treatment. Conclusions: Prompt and effective management with corticosteroid-sparing immunosuppressive therapy in children with sympathetic ophthalmia allows favorable control of the disease and retention of good visual acuity. [ J Pediatr Ophthalmol Strabismus . 2020;57(3):154–158.]

Sympathetic Ophthalmia after Vitreoretinal Surgery without Antecedent History of Trauma: A Systematic Review and Meta-Analysis

“…After the title and abstract screening, we excluded 188 studies, and only 20 full-text studies were retrieved and assessed for final eligibility. Furthermore, an additional 5 articles were excluded because SO was neither triggered by VR surgery procedures in eyes without an antecedent history of trauma nor epidemiologic SO rates after VR surgery were investigated, resulting in 15 studies included in the systematic review [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…Among the 15 studies included in the qualitative analysis, all [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] except two studies [ 11 , 16 ] reported the exact number of SO over a specific period. Indeed, these studies reported only SO’s clinical presentation, course, and outcomes following vitreoretinal surgeries.…”

“…Several surgical procedures have been reported as the primary triggers of SO, including cyclo-destructive procedures, cataract surgery, glaucoma filtration surgery, evisceration, and retinal laser photocoagulation [ 5 ]. Since the 1980s, the association between vitreoretinal (VR) surgery and SO has been investigated, and in recent years, ocular surgery, especially vitrectomy, has become an increasingly prevalent risk factor for SO [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, most of these studies are heterogeneous, and they did not highlight well whether VR surgery alone or in combination with other surgical procedures in eyes with or without a history of previous ocular surgery or trauma represented the inciting event causing SO.…”

Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies?

“…Dutta Majumdar et al found that a final visual acuity of at least 20/40 could be maintained in 70% of sympathizing eyes of 20 cases with pediatric SO. 175 Three exciting eyes also had a good visual outcome. Seventeen of 20 patients received immunomodulatory therapy in addition to systemic steroids.…”

Sympathetic ophthalmia: A comprehensive update

“…Commonly used agents include mycophenolate mofetil, azathioprine, cyclosporine, and cyclophosphamide. [ 38 62 63 64 65 ] The latter is used for refractory cases given its severe systemic toxicity [ Fig. 13 ].…”