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S. R. Dubovy, Jr., H. Aziz, M. Reyes, H. Flynn, Jr., J. Davis; Sympathetic Ophthalmia: A Clinicopathologic Correlation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5854.
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To correlate the clinical course of the sympathizing eye in sympathetic ophthalmia with the histopathological findings of the inciting eye.
Retrospective case series. Specimens of the enucleated inciting eye of 16 patients diagnosed with sympathetic ophthalmia were reexamined for histologic indicators of the severity of inflammation. Clinical data from the course of the sympathizing eye included history of exudative detachment, visual acuity at 6 months after enucleation, control of inflammation at 6 months, and use of immunosuppressive drugs or corticosteroids.
Histopathologic evaluation of the inciting eye disclosed 7 of 16 globes without diffuse granulomatous inflammation and 9 of 16 showed changes consistent with sympathetic ophthalmia. Optic nerve atrophy was detected in 7 of 16 globes. In the globes with the histopathologically confirmed sympathetic ophthalmia, Dalen-Fuchs nodules were present in 5 of 9 eyes and eosinophils were detected in 9 of 9 globes. All patients with negative histology were taking corticosteroids at the time of enucleation vs.2 of 9 patients with positive histology. Exudative detachment occurred in no patients with negative histology and in 6 of 9 patients with positive histology (p = .05). The median follow-up after enucleation was 5.4 years (range 2 months to 16.2 years). At 2-3 months after enucleation, 4 of 7 patients with negative histology had a visual acuity of > 20/40 compared to 7 of 9 patients with positive histology (NS). At the 6 month visit, 10 of 10 remaining patients were receiving an immunosuppressive agent, of whom 4 were also receiving oral corticosteroids.
Clinically diagnosed sympathetic ophthalmia with negative histopathological findings is less likely to be associated with exudative retinal detachment in the sympathizing eye. Eosinophils were found in 100% of enucleated eyes with positive histology vs Dalen-Fuchs nodules in 56% of eyes with positive histology. .
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