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Abhishek R Payal, C Stephen Foster; Long-Term Drug-Free Remission and Visual Outcomes in Sympathetic Ophthalmia. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2515.
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Sympathetic ophthalmia (SO) has an unpredictable but often chronic course requiring prolonged corticosteroid or immunosuppressive therapy (IST) or a combination of both. The therapy itself may result in additional complications in the remaining good eye. We assessed corticosteroid and IST free long-term remission in the treatment of patients with sympathetic ophthalmia.
Retrospective case series of 19 patients with sympathetic ophthalmia treated with corticosteroids and immunosuppressive therapy with a step-ladder protocol practiced at this center between March 2005-October 2013. Primary outcomes were five-year and two-year remission rates with and without corticosteroids and immunosuppressive therapy; and visual acuity.
Nineteen patients (10 females, 9 males) with sympathetic ophthalmia, meeting inclusion criteria were identified for review. Patients were in the age range of 16.1-94.95 years (median age 58.56 years). Median follow-up was 7.10 years (mean, 6.41; range, 2.5 to 8.63 years). All patients achieved remission, thirteen of them for 2 years or more. Three (15.78%) of the 19 patients maintained remission off all immunosuppressive therapy and corticosteroids for more than 5 years with vision of 20/25 or better in the sympathizing eye. Thirteen patients (68.42%) were in remission on immunosuppressive therapy or corticosteroids or in combination therapy. Eleven patients (57.9%) maintained visual acuity of 20/40 or better at the end of follow up.
Even with a devastating and possibly lifelong disease like sympathetic ophthalmia, long-term remission off all immunosuppressive therapy and corticosteroids, perhaps even cure, is possible. It is worthwhile to consider immunosuppressive therapy early in the management of sympathetic ophthalmia for better outcomes. Studies with longer follow-up might provide additional evidence to support this.
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