Diana Dmuchowska_SCIENTIFIC POSTER 2015

Objective:

Sympathetic ophthalmia is a diffuse, granulomatous panuveitis that may develop after surgical trauma to the exciting eye, followed by the appearance of uveitis in the sympathizing eye. We present the course of sympathetic ophthalmia with atypical onset.

Method:

Interventional single case report.

Results:

In March 2014, a 59-year-old female with a history of cataract operation with IOL implantation (OD, 2001), cataract surgery complicated with expulsive choroidal hemorrhage (OS, 2004) and cerclage due to macula-on retinal detachment (OD, 2007), presented with total retinal detachment OD. The subretinal fluid absorbed completely within one day and no signs of active inflammation of anterior and posterior segment were detected. No treatment was implemented but the patient was followed-up. The exudative retinal detachment recurred in April 2014 but again spontaneously resolved within a few days. Despite the lack of inflammation, the patient received intravenous steroids. In August 2014, she reported deterioration of vision, new onset slight photophobia, and minimal discomfort of both eyes lasting for a month. Anterior and intermediate inflammation OD was observed with no signs of posterior subretinal infiltration. FA revealed CME without the signs of multifocal choroiditis. Sarcoidosis, syphilis, Lyme disease and zoonoses were excluded. The results of chest X-ray, abdomen and carotid ultrasound, head MRI, and the levels of tumor markers were normal. Based on the history of bilateral surgeries, evidence of intraocular inflammation and good response to steroids, the patient was diagnosed with sympathetic ophthalmia. She received topical steroids, NSAIDs, mydriatics and intravenous steroids. The anterior uveitis and CME improved. The steroids were continued orally with stepwise tapering and maintenance dosage of 5 mg prednisone. The ICG performed in November 2014 was unremarkable which does not exclude the presence of an inactive sympathetic ophthalmia. As recurrent mild anterior uveitis was diagnosed in February 2015, topical steroids were administered and the maintenance dose of prednisone was increased to 10 mg.

Conclusions:

1. Spontaneously resolving recurrent exudative retinal detachment, not necessarily accompanied by clinically detectable uveitis, may be an initial manifestation of sympathetic ophthalmia.

2. Anterior and intermediate uveitis may manifest up to 5 months later.

3. Steroids constitute effective treatment for sympathetic ophthalmia.

Contact Details:

Email: diana_anka@op.pl
Cell Phone: +447459328031