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

Abstract

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.

Optical coherence tomography imaging in uveitis

“…Gupta et al [113] analyzed six consecutive patients diagnosed with sympathetic ophthalmia. All patients underwent FA and Cirrus HD-OCT scan and were treated with high-dose systemic corticosteroids.…”

Multimodality Diagnostic Imaging in a Case of Sympathetic Ophthalmia

“…2 Although there have been case reports describing SD-OCT findings in sympathetic ophthalmia and review of the images shows choroidal thickening at initial presentation, this was not performed with EDI SD-OCT as described by Spaide and coauthors. [4][5][6] Further, the authors were not able to document improvement of choroidal thickening following treatment. 4,5 Wide-field fundus autofluorescence also showed initial hyperautofluorescence corresponding to accumulation of subretinal fluid that turned to areas of speckled areas of hyperand hypoautofluorescence similar to the leopard-spot appearance following resolution of VKH or SO well described in literature.…”

“…[4][5][6] Further, the authors were not able to document improvement of choroidal thickening following treatment. 4,5 Wide-field fundus autofluorescence also showed initial hyperautofluorescence corresponding to accumulation of subretinal fluid that turned to areas of speckled areas of hyperand hypoautofluorescence similar to the leopard-spot appearance following resolution of VKH or SO well described in literature. Ours is the first report describing the use of wide-field fluorescein angiography, fundus autofluorescence, and EDI SD-OCT to the best of our knowledge.…”

Retinal imaging in uveitis

“…47 The retina inner to external limiting membrane did not show any remarkable structural alteration in VKH and sympathetic ophthalmia patients and the changes seen in outer retina segment in sympathetic ophthalmia were reversible. 48 …”

“…Scleral edema associated with fluid within Tenon's space results in an echoluscent region just posterior to the sclera results in the classic ''T'' sign. 48 …”