Recent advances in diagnosis and management of sympathetic ophthalmia

Abstract

Purpose of reviewSympathetic ophthalmia is a bilateral granulomatous uveitis that occurs following unilateral trauma or surgery and is sight-threatening in the contralateral eye. Despite significant potential morbidity, disease remains poorly understood. Variable presentations and clinical courses, as well as a lack of definitive diagnostic laboratory tests can complicate the diagnosis and result in delayed treatment, which can beget permanent vision loss. This review focuses on recent advances in areas of pathophysiology, classification, diagnosis and treatment. Recent findingsSympathetic ophthalmia is thought to involve a cell-mediated immune response to retinal and uveal antigens exposed through trauma or surgery. Multiple mechanisms have been implicated, including activation of the interleukin-23/IL-17 pathway. Ongoing emphasis is placed on early disease recognition and prompt treatment with multimodal imaging. Multiple authors advocate for the routine use of optical coherence tomography (OCT) for screening and disease monitoring. Systemic steroids and steroids sparingimmunosuppressive agents remain the mainstay of treatment.

Case report: Sympathetic ophthalmia after vitrectomies in a patient with Von Hippel–Lindau syndrome

“…In a recent study, the risk of developing SO rose exponentially with the number of vitreoretinal surgeries, 10.3389/fmed.2023.1118913 Frontiers in Medicine 02 frontiersin.org although it was low after a single vitreoretinal procedure (4). Improvements in multimodal imaging techniques help to understand the pathogenesis of SO, aid the early diagnosis of SO, and monitor disease progression and response to therapy (5). However, there have been few follow-ups of imaging changes from the first inciting event to the final diagnosis of SO.…”