Methotrexate for sympathetic ophthalmia: A report of 3 cases

@#OBJECTIVE: To describe the visual and clinical outcomes of 3 patients with sympathetic ophthalmia treated with a combination of systemic steroids and methotrexate. METHODS: This was a small, descriptive case series. RESULTS: We reported 3 cases of post-traumatic sympathetic ophthalmia treated with steroids and methotrexate. Two patients had inciting eyes with no light perception on presentation, while one had a best-corrected visual acuity (BCVA) of counting fingers. The initial BCVA of the sympathizing eyes ranged from 20/20 to 20/50. Control of ocular inflammation was achieved using methotrexate (12.5 to 15 mg weekly) in addition to oral steroids and topical therapy. The final BCVA of the sympathizing eyes ranged from 20/20 to 20/30, indicating that good visual outcomes were attainable with steroids and methotrexate as part of the maintenance regimen. None of the patients developed adverse side-effects from methotrexate. CONCLUSION: This small case series demonstrated the effectiveness and safety of methotrexate for control of intraocular inflammation in sympathetic ophthalmia.

Sympathetic ophthalmia with incidental finding of chicken pox supported by histopathology and immunohistochemistry

Sympathetic ophthalmia (SO) is a rare bilateral diffuse granulomatous panuveitis that occurs in few days to several years after penetrating injury. This intraocular inflammation can occur in any age group without a sex predilection. Pathology and immunohistochemistry-supported evidence is important to know the disease in a better way. We present a case of a 24-year-old female with clinical diagnosis of SO with an atypical past history of chicken pox in that eye and residual corneal opacity.

Progressive, subretinal fibrosis mimicking retinal necrosis with poor visual prognosis in sympathetic ophthalmia: A rare finding

We report a rare finding of progressive subretinal fibrosis mimicking retinal necrosis in 2 cases of sympathetic ophthalmia. Histopathology of the inciting eye and vitreous biopsy of the sympathizing eye ruled out infections and masquerades. Progression of inflammation and rapid deterioration of vision inspite of maximum immunosuppression are key findings in this variant of sympathetic ophthalmia.

Oftalmia simpática / Sympathetic ophthalmia

Resumo Relatar um caso de um paciente portador de Oftalmia Simpática (OS), com descolamento seroso da retina documentado através de tomografia de coerência óptica de domínio spectral (SD OCT), indocianina verde (ICG) e angiofluoreceinografia (AGF), que o diagnóstico foi realizado em uma consulta de rotina e iniciado tratamento clínico .

Abstract To report the case of a patient with sympathetic ophthalmia (OS), with serous detachment of retinal documented by spectral domain optical coherence tomography (OCT), indocyanine green (ICG) and angiofluorecephography (AGF). The diagnosis was made in a routine consultation and clinical treatment was initiated.

Sympathetic Ophthalmia as a Major Sight-threatening Disorder.

SO Iris and eyeball inflammatory condition affecting both eyes that occurs after a penetrating injury as a delayed autoimmune reaction to eye injury. Patients present with pain, photophobia, paresis of accommodation, metamorphopsia and mild to significant visual loss. The granulomatous anterior uveitis is accompanied by posterior segment findings including moderate to severe vitritis, choroiditis, papillitis, perivasculitis, and yellow-white lesions of the retinal pigment epithelium (Dalen-Fuchs nodules). The inflammation can lead to serious retinal detachment and macular edema. Extraocular symptoms include headache, meningitis or cerebrospinal fluid pleocytosis, hearing loss, poliosis and vitiligo. The inflammation is caused by a cell-mediated immune mechanism and autoimmune inflammatory response directed against ocular self-antigens released after the initial injury. SO may occur after ocular trauma (47 to 65% of patients) or contusions. Wounds involving the ciliary body are associated with the highest risk. Surgical interventions may also trigger SO, with posterior segment surgery carrying a higher risk than anterior segment surgery. Diagnosis of SO is mainly based on patient history and clinical presentation. Imaging studies (fluorescein or indocyanine green angiography, B-scan ultrasonography and optical coherence tomography) may be useful to confirm the diagnosis.

Epilens membrane simulating cataract in children with uveitis: a report of three cases / Membrana epicristaliniana simulando catarata em crianças com uveíte: relato de três casos

ABSTRACTHere we present the cases of three female children, of whom two were aged 6 years and one was aged 11 years. Two of the three children had bilateral uveitis and suspected cataract and Vogt-Koyanagi-Harada (VKH) disease. The third one had uveitis and suspected cataract in one eye and sympathetic ophthalmia (SO), and had undergone penetrating keratoplasty in the fellow eye following a trauma. After controlling the inflammation, we planned to perform phacoemulsification without intraocular lens implantation. However, intraoperatively, after removing the epilens membranes, the lenses appeared clear, and therefore phacoemulsification was not performed. During follow-up, the patients did not develop cataract, and visual acuity levels ranged from 20/30 to 20/100. Fundoscopy revealed VKH disease and SO. Ophthalmologists should not always assume that patients with uveitis have cataract; a transparent lens may exist behind the epilens membrane, allowing a less aggressive therapeutic approach.

RESUMOApresentamos os casos de três meninas (duas de seis anos e uma de onze anos), com uveíte bilateral e suspeita de catarata em ambos os olhos e doença de Vogt-Koyanagi-Harada (VKH) em dois casos. No terceiro caso, oftalmia simpática e suspeita de catarata em um olho e trauma com ceratoplastia penetrante no outro olho. Após controle da inflamação, indicou-se facoemulsificação sem LIO. No per-operatório, após retirada da membrana epicristaliniana, a transparência do cristalino foi percebida, não sendo realizada a facoemulsificação. No período de acompanhamento as pacientes não desenvolveram catarata e a acuidade visual variou de 20/30 a 20/100. O exame de fundoscopia reforçou o diagnóstico de VKH e oftalmia simpática. Portanto, é muito importante que o oftalmologista esteja sempre atento quando se deparar com um caso de uveíte com suspeita de catarata, porque, por trás da membrana epicristaliniana pode existir um cristalino transparente, o que leva a uma conduta terapêutica menos agressiva.

A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

PURPOSE: To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma. CASE SUMMARY: A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed. CONCLUSIONS: Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.

Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes

PURPOSE: To investigate the clinical outcome of glaucoma surgery performed in patients with painful blind glaucomatous eyes. METHODS: A single-center, retrospective, interventional case series was performed by reviewing the medical records of 74 glaucoma patients (74 eyes) who underwent Ahmed glaucoma valve (AGV) implantation or trabeculectomy for painful blind eyes from October 2004 to January 2014. Blindness was defined as visual acuity less than hand motion at the time of surgery. Preoperative and postoperative intraocular pressure (IOP), number of anti-glaucoma medications, and presence of pain were compared in the patients grouped according to the type of glaucoma surgery. The glaucoma type, history of previous glaucoma surgery and postoperative failure/complications were also evaluated. RESULTS: AGV implantation was performed in 42 eyes (56.8%) of 42 patients, and trabeculectomy was performed in 32 eyes (43.2%) of 32 patients. The average IOP decreased from 41.73 +/- 11.77 mm Hg before surgery to 14.29 +/- 9.34 mm Hg at five years after the surgery (p < 0.001, paired t-test). The IOP was not significantly different between the groups at any follow-up time point (p = 0.949, linear mixed model). Overall, three patients (4.1%) still experienced eye pain after surgery, IOP greater than 30 mm Hg was observed in eight eyes (10.8%), and additional surgery was required in 11 eyes (14.9%). Evisceration was required in only two eyes (2.7%). Sympathetic ophthalmia was not found in any patient during the follow-up period. CONCLUSIONS: Glaucoma surgery including AGV implantation/trabeculectomy was effective and safe even for painful blind eyes. The procedure may be considered as an alternative to enucleation as an initial surgical option for painful blind glaucomatous eyes.

Sympathetic Ophthalmia - A Potentially Blinding Complication Following Orbital Injuries.

Sympathetic Ophthalmia is a rare but serious complication that can occur following penetrating injuries of the globe of the eye. So far the only known method of preventing this is to remove the injured eye. The purpose of this paper is to make the maxillofacial surgeons to be familiar with this serious complication in order that measures can be instituted early to prevent loss of vision in the uninjured eye.

Sympathetic Ophthalmia: Mangement and Role of Immunosuppressants.

Presented here is a case of sympathetic ophthalmia that provided us an opportunity to evaluate the eficacay of immunosuppressive drugs with steroids in reduced doses and their outcome in improving thevisual loss in a young patient who had fast deterioration in his visual acuity.

Ginicopathologic Features of Sympathetic Ophthalmia of 7 Cases following Intra-ocular Surgery / 第二军医大学学报

A retrospective clinicopathologic review of 174 eyeball specimens which were enucleated following intra-ocular surgery was made. It was found that there were 7 cases of sympathetic ophthalmia (SO), of which 4 cases were associated with lens-induced ophthalmitis (LIO). The shortest latent period of SO in this series was 2 weeks. Pathologically, there was an unclosed eyeball caused by a poorly healed incision with incarceration of uvea tissue, besides the characteristics of SO. The results suggest that the poor healing of the incision made in intra-ocular surgery may be strongly correlated with SO.