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J.K. Lee, A. Webster, J. Kim, H. Engel, U. Mian; Sympathetic Ophthalmia Associated With Bleb–Related Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5285.
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Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis, associated with ocular trauma or surgeries, with potentially devastating consequences. Although infrequent, the incidence of endophthalmitis after trabeculectomy is higher than after most intraocular procedures. This case is the first report of sympathetic ophthalmia associated with bleb–related endophthalmitis.
A 77 year old male with an ocular history of POAG, status–post trabeculectomy OU presented with a one–week complaint of pain and decrease in visual acuity in the right eye. The patient’s BCVA was counting fingers at 4 inches in the right eye and 20/50 in the left eye. Slit–lamp exam revealed an infected bleb and extensive fibrous reaction in the anterior chamber. The patient underwent an anterior chamber washout, pars plana core vitrectomy, and intravitreal injection of antibiotics and steroids. Despite prompt surgical intervention, at 1–month follow–up, the eye deteriorated to NLP vision and painful phthisis bulbi. While awaiting enucleation, at 2–month follow–up, the patient presented with hand–motion visual acuity in the previously unaffected left eye. Slit–lamp exam revealed mutton–fat keratic precipitates in the anterior chamber (Fig. 1) and cloudy vitreous precluded a view into the retina. B–scan showed thickened choroid with vitreous debris (Fig. 2). A presumptive diagnosis of SO was made and the patient was started on oral corticosteroids. The patient’s visual acuity improved to count–fingers at one week and continued to improve to 20/50 after two months of systemic steroids. The keratic precipitates resolved (Fig. 3) and clearing of the vitreous allowed viewing of the normal retina (Fig. 4). Follow–up B–scan also showed decreased thickening of the choroid (Fig. 5).
This is the first case report of sympathetic ophthalmia associated with bleb–associated endophthalmitis. It is unclear whether this patient developed SO from endophthalmitis or vitrectomy. Regardless, this case suggests that those who manage bleb–related endophthalmitis or perform pars plana vitrectomies for them need to be alerted of SO as being a potential complication.
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