Sympathetic ophthalmia following severe fungal keratitis

Buller, Alex; Doris, J P; Bonshek, Richard; Brahma, Arun; Jones, Nicholas P.

doi:10.1038/sj.eye.6702156

“…Buller et al [10] recently reported a case of sympathetic ophthalmia after fungal keratitis and hypothesized that infection permitted the diffusion of inflammatory mediators and fungal antigens leading to a disturbed blood-retinal barrier exposing retinal antigens. Previously, it had been hypothesized that a purulent infection within the eye would destroy the uveal tissue in such a way that SO would not develop [63].…”

Section: Etiologymentioning

confidence: 99%

Sympathetic ophthalmia

Castiblanco

¹

,

Adelman

²

2008

Graefes Arch Clin Exp Ophthalmol

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“…However, there are still a few case reports on the occurrence of sympathetic ophthalmia after endophthalmitis [2, 21]. Buller and associates reported a case of sympathetic ophthalmia following severe fungal keratitis, and hypothesize that chronic fungal infection allowed diffusion of intraocular microorganism antigens and proinflammatory mediators through a disturbed blood-retinal barrier to expose retinal antigens [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are still a few case reports on the occurrence of sympathetic ophthalmia after endophthalmitis [2, 21]. Buller and associates reported a case of sympathetic ophthalmia following severe fungal keratitis, and hypothesize that chronic fungal infection allowed diffusion of intraocular microorganism antigens and proinflammatory mediators through a disturbed blood-retinal barrier to expose retinal antigens [2]. In one retrospective case series, 4 of 26 patients clinically diagnosed with sympathetic ophthalmia between 2002 and 2004, had concurrent bacterial endophthalmitis, which suggested that purulent endophthalmitis may not prevent the development of sympathetic ophthalmia [3].…”

Section: Discussionmentioning

confidence: 99%

“…Ocular surgical procedures that disrupt the integrity of the uveo-retinal tissues have lately been shown to be among the important risk factors for developing sympathetic ophthalmia, however penetrating ocular trauma also plays a central role in the incidence of the disease [1]. It has been suggested that co-existing infection may increase the immune response due to greater exposure of retinal antigens and ultimately trigger an autoimmune process that leads to sympathetic ophthalmia [2-4]. While there seems to be no overall gender or racial predilection, the higher incidence of ocular trauma in males and children may explain the higher incidence of sympathetic ophthalmia in these groups reported in some series [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Classical Pathology of Sympathetic Ophthalmia Presented in a Unique Case

Chen¹,

Aronow²,

Wang³

et al. 2014

TOOPHTJ

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The ocular pathology of sympathetic ophthalmia is demonstrated in a 10 year-old boy who sustained a penetrating left globe injury and subsequently developed sympathetic ophthalmia in the right eye two months later. Two and a half weeks following extensive surgical repair of the left ruptured globe, he developed endophthalmitis and was treated with oral and topical fortified antibiotics. One month after the initial injury, a progressive corneal ulcer of the left eye led to perforation and the need for emergent corneal transplantation. The surgical specimen revealed fungus, Scedosporium dehoogii. The boy received systemic and topical anti-fungal therapy. Two months following the penetrating globe injury of the left eye, a granulomatous uveitis developed in the right eye. Sympathetic ophthalmia was suspected and the patient began treatment with topical and oral corticosteroids. Given the concern of vision loss secondary to sympathetic ophthalmia in the right eye, as well as poor vision and hypotony in the injured eye, the left eye was enucleated. Microscopically, granulomatous inflammation with giant cells was noted within a cyclitic membrane which filled the anterior and posterior chamber of the left globe. Other classic features including Dalen-Fuchs nodules were identified. Small, choroidal, ill-defined granulomas and relative sparing of the choriocapillaris were present. Molecular analysis did not identify evidence of remaining fungal infection. The pathology findings were consistent with previously described features of sympathetic ophthalmia. The present case is unique in that co-existing fungal infection may have potentiated the risk for developing sympathetic ophthalmia in the fellow eye.

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“…after infectious 13,14 or chemical keratitis, 15 and in association with non-penetrating procedures, including irradiation for ocular melanoma [16][17][18][19][20] and laser-and cryocyclodestructive procedures to lower intraocular pressure. [21][22][23][24][25][26] The time from surgery or trauma to onset of SO varies from days to decades, with the vast majority of cases occurring within 12 months.…”

mentioning

confidence: 99%