Sympathetic ophthalmia following vitreoretinal surgery

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, SF(6) injection and 360 degrees 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.

Epidemiology and pathogenesis of uveitis: A review

“…The disease has been noted in about 0.01% of patients who had undergone parsplana vitrectomy. 25,26 The exact cause of sympathetic ophthalmia is unknown. The disease was found to be associated with HLA-A1 in 32% of the subjects.…”

Sympathetic Ophthalmia Two Weeks After 23-Gauge Vitrectomy

“…The possible association between vitrectomy and SO has been initially proposed by Gass [9] and later studied extensively in a large cohort in the United Kingdom with an estimated SO risk of 1 in 799 vitrectomies [11]. There have been several case series and reports of SO following vitrectomy, however only three documented cases of SO following vitrectomy without use of silicone oil with an onset of SO ranged between 4 weeks to 2 months.…”

Sympathetic ophthalmia: to the twenty-first century and beyond

“…Sympathetic ophthalmia is a concern following multiple intraocular surgeries such as cataract extraction, paracentesis, and iridectomy, and is of particular concern following vitreoretinal surgery. Vitreoretinal surgeries such as pars plana vitrectomy and retinal detachment repair are risk factors for sympathetic ophthalmia, either through trauma-related issues or rhegmatogenous retinal detachment [56]. To date, vitreoretinal surgery is suggested to be the cause behind half of all sympathetic ophthalmia cases and, thus, up to 1 out of every 800 vitreoretinal cases [19].…”