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Evgenia Anikina, Siegfried Karl Wagner, Sidath Liyanage, Paul Sullivan, Carlos Pavesio, Narciss Okhravi; Sympathetic Ophthalmia – Then to Now and the Effect of Multiple Trigger Events. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6666.
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© ARVO (1962-2015); The Authors (2016-present)
Sympathetic ophthalmia (SO) remains an incompletely understood condition, with varying reports of incidence, especially following one or more vitreoretinal (VR) procedures. We performed a retrospective review of the changes in patients with SO, in particular examining surgical factors conferring a higher risk of this disease.
An all-records search of the electronic patient records system at Moorfields Eye Hospital, London over the years 2000- 2015 was performed. 72 patients with confirmed SO were identified and 61 records were available for detailed review.
42/61 male (69%) and 19 female (31%) patients with an age range at diagnosis of 4-85 years (mean 40) were diagnosed with SO between 1938-2015. The range of follow up length was 1-75 years (mean 23 years).Vitreoretinal surgery (without preceding trauma) accounted for 13 of the 21 first event surgical triggers (62%). Of these 13, 10 patients had had multiple VR procedures. 23/61 patients (38%) underwent VR surgery (1-7 operations) at some point prior to diagnosis. Multiple procedures were common (38 patients; 62%). Surgical details were available for 15/23 patients, who underwent their operations at Moorfields.Based on Moorfields activity data, the risk of developing SO following a single VR procedure was gauged to be 0.006%, rising to 6.25% with 7 procedures.By the last available follow up visit, visual acuity (VA) had improved in 9 (15%), was unchanged in 18 (30%) and was worse in 23 (38%). There was high incidence of cataract, glaucoma and other ocular comorbidities confounding visual acuity. Amongst the VR cohort, the VA had improved in 7/23 (30%) and reduced in 14/23 (61%).48 patients received oral steroids as a first line treatment (6 no oral therapy, 7 unknown), with 26 of these patients concurrently on second line agents.
SO remains a rare clinical phenomenon and its incidence amongst routine surgical patients is lower than previously estimated. Multiple surgical procedures and/or combination of trauma and surgery confer a significantly higher risk of developing SO.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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