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Brian L. VanderBeek, Susan G. Elner; Sympathetic Ophthalmia: Experience from a Tertiary Care Facility. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2757.
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Sympathetic Ophthalmia is a rare bilateral panuveitis known to occur after trauma and can have devastating effects on vision. In this report we share a tertiary care referral center’s experiences with sympathetic ophthalmia and further discuss its clinical course and optimal treatment recommendations.
We performed a retrospective chart review of consecutive patients that were diagnosed and treated for sympathetic ophthalmia at our facility over the last twenty years. Main outcome variable studied was final visual acuity. Secondary variables examined included age, gender, type of ocular surgery, initial visual acuity, number of surgeries, time from most recent surgery or trauma to symptoms, time from symptoms to diagnosis, time from symptoms to systemic immunosuppression, and where indicated time to enucleation.
Nine patients, aged 23 to 81 years, with an average follow up of 73 months (range 22-168 months) were included. Of the 4 patients who had systemic immunosuppressive medications started within 1 month of symptom onset, 2 had a final visual acuity of 20/20, neither of whom required further systemic medications once the disease became inactivated. Of the 5 who were not given systemic immune suppression prior to 6 weeks after symptom onset, none had a better final visual acuity than 20/300 in the sympathizing eye, and 2 were maintained on long term immunosuppressive medications. Enucleation was performed in 7 of the 9 patients with 2 occurring prior to symptom onset. All 5 patients who had enucleation after symptom onset had the diagnosis confirmed on histopathology.
Early recognition leading to earlier aggressive systemic immunosuppression improves the visual outcome in patients, particularly if treatment is started within 1 month of symptom onset. Enucleation of blind-inciting eyes even if not helpful in improving final visual outcome, can provide definite confirmation of this often blinding disease.
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