Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India

Gupta, Vishali; Gupta, Amod; Dogra, Mohit

doi:10.1038/sj.eye.6702927

Cited by 51 publications

(61 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, several new studies have indicated that this description may represent just one part of the entire disease spectrum. Retinal involvement in the form of exudative retinal detachment, yellow-white mid-peripheral nodules, disc edema, vasculitis, peripapillary subretinal neovascularization and APMPPE-like lesions with exudative retinal detachment has been reported in several clinical studies using the term posterior sympathetic ophthalmia for cases with predominant retinal involvement [2,9,10]. It has also been speculated that the posterior form of the disease may actually be the early stage of sympathetic ophthalmia.…”

Section: Discussionmentioning

confidence: 95%

“…We found that classic presentation was rather uncommon in the majority of our patients who presented with posterior sympathetic ophthalmia with minimal/no anterior segment inflammation [2]. The fundus lesions at presentation in our series included exudative retinal detachment, yellow-white midperipheral nodules, disc edema, vasculitis, peripapillary subretinal neovascularization and acute posterior multifocal placoid pigment epitheliopathy (APMPPE)-like lesions with exudative retinal detachment associated with minimal or no anterior segment inflammation and vitritis [2].…”

Section: Introductionmentioning

confidence: 93%

See 1 more Smart Citation

Reversible retinal changes in the acute stage of sympathetic ophthalmia seen on spectral domain optical coherence tomography

Gupta

Dogra

et al. 2011

Int Ophthalmol

View full text Add to dashboard Cite

To report the changes seen in the photoreceptor layer during the acute phase of sympathetic ophthalmia. Six consecutive patients diagnosed with sympathetic ophthalmia were enrolled in the study. All 6 patients had a fundus fluorescein angiogram and spectral domain optical coherence tomography (OCT) scan carried out at presentation. The outer retinal segment was demarcated on the raster line scan between the external limiting membrane (ELM) and the retinal pigment epithelium (RPE)-choriocapillaris complex. All patients received intravenous methylprednisolone followed by oral corticosteroids 1-1.5 mg/kg/day. The serial follow-up OCT scans taken 48 h after the initiation of treatment, and 1, 2 and 12 weeks later, were studied and compared. The retina inner to the ELM did not show any remarkable structural alteration in any of the eyes. The outer retinal segment demarcated by the ELM and the RPE-choriocapillaris complex showed serous retinal detachment in all the eyes and elongation of photoreceptors could be seen in four eyes. There was a disruption to the continuity of the two inner hyper-reflective bands in all the eyes. A repeat raster line scan performed 48 h after systemic corticosteroid therapy showed a reduction in the height of the serous retinal detachment with elongation of photoreceptors and the protrusion of their apical segments into the serous detachment in 4 eyes. The serous detachment showed a progressive reduction in height following intravenous methyprednisolone therapy in all the eyes over the following week with elongated photoreceptors in all six eyes. After two weeks, none of the eyes showed any residual detachment and this corresponded with the improvement in visual acuity in all the eyes. OCT raster line scans repeated at 4 weeks showed resolution of serous detachment with normal photoreceptor layer and restoration of a third hyper-reflective band (IS/OS junction) in all the eyes. The photoreceptor layer is involved during the acute phase of sympathetic ophthalmia as indicated by the in vivo morphological changes seen on spectral domain OCT. These changes are reversible following systemic corticosteroid therapy thus supporting the hypothesis that prompt and aggressive anti-inflammatory therapy is capable of reversing the photoreceptor changes.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 93%

Reversible retinal changes in the acute stage of sympathetic ophthalmia seen on spectral domain optical coherence tomography

Gupta

Dogra

et al. 2011

Int Ophthalmol

View full text Add to dashboard Cite

show abstract

“…Initial anterior segment changes can sometimes be absent and SO may present with posterior segment findings only. In a very recent report of 40 consecutive patients from India [19], 22 patients presented with fundus lesions without any accompanying anterior segment finding. Although the most common inciting event was trauma, 10 exciting eyes had undergone surgery; two of which had scleral buckle with subretinal fluid drainage and two had PPV.…”

Section: Discussionmentioning

confidence: 96%

Sympathetic ophthalmia following vitreoretinal surgery

et al. 2009

View full text Add to dashboard Cite

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.

show abstract

“…The clinical appearance of SO varies within a mild to severe range. In a long-term study of Gupta et al, the most important posterior segment manifestations were exudative retinal detachment in the majority of patients, Dalen-Fuchs nodules, papillitis, and vasculitis as secondary events [ 103 ]. The complications of chronic infl ammation include secondary glaucoma, cataract, and chronic maculopathy.…”

Section: Clinical Symptoms and Signsmentioning

confidence: 98%

“…The complications of chronic infl ammation include secondary glaucoma, cataract, and chronic maculopathy. Misdiagnosis and inappropriate treatment of this condition may result in severe infl ammatory sequela such as retinal and optic atrophy, infl ammatory choroidal neovascularization (CNV), choroidal atrophy, and phthisis bulbi [ 103 ]. Rarely, SO may be associated with the typical extraocular fi ndings accompanying Vogt-Koyanagi-Harada syndrome, such as alopecia, vitiligo, cells in the cerebrospinal fl uid, and dysacousia.…”

Section: Clinical Symptoms and Signsmentioning

confidence: 99%