Sympathetic ophthalmia: Report of a case series and comprehensive review of the literature

Abstract

Purpose: To evaluate the factors related to sympathetic ophthalmia (SO) in a series of patients in our ophthalmology center and previously published cases. Methods: A retrospective and noncomparative review was performed on 16 patients with SO attending our ophthalmology center from 2013 to 2019. A total of 87 previously published cases of SO were identified by searching the Medline database from 2009 to 2019. Results: Sixteen patients were included in the analysis, and six cases were induced by transscleral cyclophotocoagulation (TCP). All patients had achieved controlled inflammation at their last follow-up visit. Thirteen patients (81.3%) had improved best-corrected visual acuity (BCVA). A review of the literature revealed 87 previously reported cases of SO. Shared clinical features and treatment outcomes were summarized. Conclusion: Ocular therapies, including both penetrating ocular therapy and non-penetrating ocular intervention, have become increasingly prevalent risk factors for SO, and the latent period has increased compared to past reports. Visual prognosis with appropriate medical management is relatively good.

Sympathetic ophthalmia: A comprehensive update

“…Commonly used agents include mycophenolate mofetil, azathioprine, cyclosporine, and cyclophosphamide. [ 38 62 63 64 65 ] The latter is used for refractory cases given its severe systemic toxicity [ Fig. 13 ].…”

Sympathetic Ophthalmia: Demographic Characteristics, Clinical Findings, and Treatment Results

“… 1 The traumatized or operated eye is referred to as the “sympathetic” or “inciting” eye and the other as the “sympathizing” eye. 2 SO can develop within the first few days after ocular injury or surgery or even years later. Cases developing between 5 days and 66 years later have been reported in the literature.…”

Clinical and imaging features of sympathetic ophthalmia and efficacy of the current therapy

“…multifocal hypofluorescence in FFA) had been widely reported (Chang & Young 2011;Chu & Chan 2013;Varghese & Raghavendra 2013), their corresponding incidence, as well as other possible rare symptoms, ocular manifestations or imaging features were largely inconclusive. A better understanding of the clinical features of SO might facilitate early diagnosis and timely immunotherapy; (3) the prognosis of SO was still controversial, and the reported incidence of patients with favourable visual outcomes and well inflammation control varied significantly from 11% to 100% (Hakin et al 1992;Yang et al 2021). ( 4) given the small sample size of previous studies and the rarity of SO (minimum incidence of 0.03 cases per 100 000 people) (Kilmartin et al 2000), the conclusions supported by previous studies might not be generalizable, and their rating of the evidence level was also not high enough to be solid reference; (5) several authors did suggest that a proper meta-analysis should be performed to collect all the related evidence, in order to ultimately give a full picture of SO.…”

“…1992; Yang et al. 2021). (4) given the small sample size of previous studies and the rarity of SO (minimum incidence of 0.03 cases per 100 000 people) (Kilmartin et al.…”

“…Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous uveitis that can present after an inciting event, such as ocular trauma or intraocular surgical interventions (Yang et al. 2021). The eye that sustains the inciting event is the ‘inciting’ eye, and the fellow eye is the ‘sympathizing’ eye.…”