Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report

Abstract

This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophtalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema. ABSTRACT RELATOS DE CASOS

Multimodal Imaging in a Case of Chronic Sympathetic Ophthalmia

“…ICGA is a crucial adjunct to FFA in the diagnosis of these entities, as the choroid is primarily involved in both pathologies. In acute SO, ICGA shows multiple hypocyanescent spots corresponding to choroidal infiltration with inflammatory cells and Dalen-Fuchs nodules on histopathological examination [ 8 , 9 ]. However, ICGA findings in chronic SO have not been frequently described in the literature, with inconsistent findings in rare case reports, such as one by Bernasconi et al [ 8 ].…”

Sympathetic Ophthalmia

“…However, if the hypocyanescent spots faded in the late phase, then these spots likely indicated active choroiditis [57]. However, Casella et al reported that even when the hypocyanescent spots persisted through the late phases, comparison with histopathologic findings and FA revealed that these spots corresponded to Dalen-Fuchs nodules and not chorioretinal atrophy [58] as posited by Bernasconi and colleagues [57]. Of interest, these hypocyanescent spots were observed to resolve after treatment and paralleled clinical improvement [58].…”

“…However, Casella et al reported that even when the hypocyanescent spots persisted through the late phases, comparison with histopathologic findings and FA revealed that these spots corresponded to Dalen-Fuchs nodules and not chorioretinal atrophy [58] as posited by Bernasconi and colleagues [57]. Of interest, these hypocyanescent spots were observed to resolve after treatment and paralleled clinical improvement [58]. Moshfeghi et al showed that although the posttreatment early and intermediate phases of ICGA appeared normal, the hypocyanescent spots reappeared in the late phases [59].…”

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

“…These spots occur due to the presence of cellular infiltration of the choroid, DF nodules, or overlying edema. Casella et al 100 showed that these hypocyanescent spots persist throughout the phases of ICGA. These hypocyanescent spots are noted to lessen or vanish once the treatment with corticosteroid is started and are consistent with clinical improvement.…”