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

Paulbuddhe, Vivek; Addya, Sujit; Gurnani, Bharat; Singh, Dheerendra; Tripathy, Koushik; Chawla, Rohan

doi:10.2147/opth.s289688

Cited by 13 publications

(6 citation statements)

References 154 publications

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“…The absence of these findings ruled out VKH syndrome in our patient. Multifocal neurosensory retinal detachment is also seen in sympathetic ophthalmia; however, this condition was excluded as our patient lacked a history of any surgical or penetrating trauma to the eye, which is often the inciting event in the development of sympathetic ophthalmia [18]. Preeclampsia/eclampsia-associated retinopathy can also present with blurred vision, serous retinal detachment, choroidal dysfunction, retinal hemorrhages, cotton wool spots, and macular edema [19].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Lupus Chorioretinopathy in a Patient With Active Systemic Lupus Erythematosus

David¹,

Davidson²,

Григорян³

2022

Cureus

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Ocular involvement is commonly seen in systemic lupus erythematosus (SLE). However, chorioretinopathy is an easily missed ocular manifestation of SLE. Early recognition and a multidisciplinary treatment approach can play a key role in reducing the ocular and systemic morbidity seen with this condition. This case report describes a patient with active SLE who presented with bilateral lupus chorioretinopathy. The patient demonstrated a significant improvement in ocular symptoms once the systemic disease was controlled.

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Section: Discussionmentioning

confidence: 99%

Bilateral Lupus Chorioretinopathy in a Patient With Active Systemic Lupus Erythematosus

David¹,

Davidson²,

Григорян³

2022

Cureus

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“…The sole pertinent recent event was the surgery conducted on the fellow eye four months earlier, prompting suspicion of sympathetic ophthalmia (SO). Initial treatment for SO involves corticosteroids, while alternative immunomodulators and immunosuppresors have been traditionally contemplated for refractory and relapsing cases when tapering down corticosteroid treatment (7). Nevertheless, for conditions such as SO, the early initiation of these medications has proven effective in improving longterm visual outcomes and minimizing ocular complications (8).…”

Section: Discussionmentioning

confidence: 99%

Purpureocillium Lilacinum-Related Endophthalmitis: Case Report

Ros-Sánchez,

Oliver-Gutierrez,

Buck

et al. 2024

Preprint

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PURPOSE To report a case of Purpureocillium lilacinum endophthalmitis METHODS The case of a fungal endophthalmitis caused by Purpureocillium lilacinum documented in an immunocompetent patient with no apparent trigger. RESULTS A 64-year-old male with a two-month history of panuveitis in his left eye was referred to our hospital. Initially misdiagnosed as sympathetic ophthalmia due to a previous surgery on his right eye 4 months before the onset of the left ocular picture, the patient received corticosteroid treatment, leading to a rapid deterioration of the left eye condition. An urgent exploratory vitrectomy was performed to identify the underlying cause, revealing endophthalmitis. Microbiological investigation yielded Purpureocillium lilacinum as the causative agent. Despite intensive treatment, including intravitreal antibiotics and antifungals, along with another surgical intervention, clinical evolution remained unfavourable, ultimately leading to the evisceration of the affected eye. CONCLUSIONS Purpureocillium lilacinum poses a rare yet sever threat as a causative agent of fungal endophthalmitis. Managing such cases is challenging due to the delayed identification, fungus’s resistance to common antifungals, and its association with prior corticosteroid misuse in most patients. This case underscores the crucial importance of heightened clinical suspicion, early diagnosis, and the exploration of alternative treatment strategies in addressing Purpureocillium lilacinum endophthalmitis. The challenges posed by this rare fungal pathogen emphasize the need for a multidisciplinary approach and continued research to improve outcomes in these complex cases.

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“…Jonas et al [ 19 ] reported on a patient with SO who developed severe Cushing’s disease after long-term treatment with systemic steroids, including steroid-induced diabetes mellitus, arterial hypertension, and obesity. To improve the prognosis, a combination of steroids, antimetabolites [ 20 ], or biologic immune modulators [ 21 ] is now commonly used at the onset of the disease. In our study, all patients received systemic steroids at presentation, and in six cases (86%), MTX, Azathioprine, mycophenolate mofetil, and TNF-α inhibitors were added to control inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Complications in patients with SO may include glaucoma, cataract formation, choroidal atrophy, maculopathy, ERD, macular edema, and phthisis bulbi [ 21 ]. The frequency of these complications varies among different studies.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes of patients with sympathetic ophthalmia

Mavris,

Amer

2024

Int Ophthalmol

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Purpose To present the long-term clinical outcomes of patients with sympathetic ophthalmia (SO). Methods Retrospective review of patients’ medical files between 2002 and 2022. Results Included were seven patients (four males). The mean ± SD age at presentation was 37.9 ± 22.5 years. Four patients had co-morbidities: three had diabetes mellitus type 2 and one had Turner Syndrome. Trauma was the inciting event in six patients and postoperative endophthalmitis in one patient. Decreased visual acuity (VA) was the leading symptom in the sympathizing eye and all of the patients presented with panuveitis. The mean ± SD interval between the triggering incident and the onset of SO in six cases was 4.3 ± 4.2 months. One case presented 30 years following the eye injury. Five patients underwent enucleation/evisceration of the exciting eye. The mean ± SD presenting LogMAR BCVA in the sympathizing eye was 0.57 ± 0.82, and the final LogMAR BCVA was 0.61 ± 0.95. Inflammation was completely controlled in 5 patients at a mean ± SD of 8.55 ± 9.21 months following the institution of immunomodulatory therapy, and it was partially controlled in 2 patients. VA deteriorated in all 3 diabetic patients and improved or remained stable in the 4 young and healthy patients. The mean ± SD follow-up period after achieving drug-free remission was 28 ± 22.8 months. The mean ± SD follow-up time was 6.8 ± 5.6 years. Conclusions SO is one of the most sight-threatening conditions, affecting the healthy eye. In this cohort, the favorable visual outcome was especially seen in young and healthy individuals. Visual prognosis is directly related to prompt diagnosis and treatment.

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

Cited by 13 publications

References 154 publications

Bilateral Lupus Chorioretinopathy in a Patient With Active Systemic Lupus Erythematosus

Bilateral Lupus Chorioretinopathy in a Patient With Active Systemic Lupus Erythematosus

Purpureocillium Lilacinum-Related Endophthalmitis: Case Report

Long-term clinical outcomes of patients with sympathetic ophthalmia

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