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R.S. Wirthlin, J.L. Davis, H.W. Flynn, I.U. Scott, S.R. Dubovy; Sympathetic Ophthalmia Clinical Features and Visual Outcome . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2697.
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Purpose: To investigate clinical features and predictors of visual acuity (VA) outcome among patients with sympathetic ophthalmia. Methods: Retrospective, consecutive, case series. The medical records were reviewed of all patients evaluated at a single institution with the diagnosis of sympathetic ophthalmia between January 1987 and December 2003. Subjects were identified by ICD–9 code 360.11. Results: The study population included 16 subjects (11 men and 5 women) with mean follow–up of 4.8 years (range, 6 months to 14 years). The mean age was 45.7 years with a standard deviation of 28. Penetrating trauma was the inciting event in 4 patients, trauma plus subsequent surgery (in addition to primary repair) in 6 patients and surgery without a history of trauma in 6. Patients who suffered trauma were significantly younger (mean age of 32.1 years versus 76.3 years). Antecedent surgical procedures included cyclophotocoagulation (1), pars plana vitrectomy (2), scleral buckling (2), and extracapsular cataract surgery (6). The interval between inciting event and diagnosis was 1.8 months to 57 years. At initial examination, VA in the exciting eye was ≥ 5/200 in 2 patients (12.5%) and ≤ hand motions in 11 (68.8%). Treatments included enucleation of the inciting eye in 9 (56.2%), topical corticosteroids in 16 (100%), oral corticosteroids in 16 (100%), antimetabolites in 7 (43.8%), subtenon’s corticosteroid in 3 (19%), and intravitreal triamcinolone acetonide in 1 (6.2%). Overall, final VA in the sympathizing eye was ≥ 20/40 in 10 cases (62.5%) and ≤ 20/400 in 3 cases (19%). A final VA ≥ 20/40 was associated with younger age (mean age of 38.0 years compared with 58.5 years), better presenting VA (mean acuity of 20/40 compared with 20/100), and a lower likelihood of being on systemic therapy at the time of last follow–up. There was no difference in the final VA between patients who underwent enucleation (mean VA 20/40, range 20/20 to 2/200) and those who did not (mean VA of 20/32, range 20/20 to 20/70). The primary reason for decreased final VA in the sympathizing eye included band keratopathy (1), cataract (1), secondary glaucoma (1), chronic exudative retinal detachment (2), retinal pigment epithelial atrophy (2), and epiretinal membrane (1). Conclusions:In the current study of sympathetic ophthalmia, predictors of good visual acuity outcome in the sympathizing eye include younger patient age and better presenting visual acuity. Because of more advanced disease, patients requiring systemic immunosuppression throughout the entire clinical course have worse final visual acuity.
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