Sympathetic Ophthalmia: Incidence of Ocular Complications and Vision Loss in the Sympathizing Eye

Abstract

Purpose: : To report the frequency on presentation and subsequent incidence of ocular complications and vision loss in the sympathizing eye of patients with sympathetic ophthalmia (SO) and to describe factors associated with decreased vision.

Methods: : Retrospective case series of 85 patients with SO at three academic, tertiary care, uveitis clinics from 1976 to 2006. Data recorded included demographics, prevalence and incidence of vision loss and ocular complications, use of oral prednisone and immunosuppressive drugs. The main outcome measures were incident visual acuity loss to 20/50 or worse and 20/200 or worse and the median acuity over time.

Results: : Twenty-six percent of patients with SO presented with a visual acuity of 20/200 or worse in their sympathizing eye. Further development of vision loss to 20/200 or worse occurred at the rate of 10% per person-year (PY). Ocular complications were seen in the sympathizing eye in 46% of patients at presentation; further development of new complications occurred in at the rate of 40%/PY. The ocular complications most often associated with decreased vision were cataract and optic nerve abnormality. Exudative retinal detachment and active disease were significantly associated with poorer visual acuity in the sympathizing eye. The benefits of corticosteroids were indirectly demonstrated as their use led to more rapid disease inactivation. Fifty-nine percent of patients maintained a visual acuity of better than 20/50 in their sympathizing eye; and 75% maintained a visual acuity of better than 20/200.

Conclusions: : Although ocular complications were seen in many eyes with SO, most patients maintained functional visual acuity. The presence of an exudative retinal detachment and active disease correlated with poorer vision in the sympathizing eye.

Keywords: uveitis-clinical/animal model • inflammation