First Author: K.Wang TAIWAN
Co Author(s): H. Chien I. Wang C. Hung
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To report a case of sympathetic ophthalmia developed after evisceration in the fellow eye
Cathay General Hospital, Taipei, Taiwan
A Case report
A 60-year-old male has a history of penetrating injury with primary repair in his left eye (LE) 30 years ago. He presented with no light perception, uncontrolled elevated intraocular pressure, and pain in his LE for 6 months, and evisceration was performed. However, 3 months after evisceration, decreased vision and floaters was noted in his right eye (RE). Best corrected visual acuity (BCVA) was 20/400 in the RE. Anterior segment revealed a few small keratic precipitates and anterior chamber reaction. Fundus examination revealed vitritis, swollen disc, and subretinal lesions consistent with creamy white lesion (Dalen–Fuchs nodules). Fluorescein angiography showed multiple early hypofluorescent lesions, hyperfluorescent in later frames, and leakage from the disc. Spectral-domain optical coherence tomography (SD-OCT) revealed hyper-reflective lesions at the level of the retinal pigment epithelium with disruption of the inner segment/outer segment (IS/OS) junction which compatible with Dalen-Fuchus nodules. Sympathetic ophthalmia (SO) was impressed (RE), and the patient was treated with systemic and topical corticosteroids. The inflammation subsided and the BCVA improved to 20/50 after 3 weeks of treatment (RE). Most Dalen–Fuchs nodules disappeared on SD-OCT
Evisceration certainly has its place in the catalogue of ophthalmic surgical technique, and it does have advantages over enucleation in specific situations. Sympathetic opthalmia (SO) is a rare but devastating complication of any ocular surgery. Although controversy involving evisceration and risk of SO has been contentious and inconclusive, a theoretically increased risk of SO must be considered in all cases. Early detection of symptoms and signs of SO is important, and the visual prognosis is good with proper treatment. On the other hand, SD-OCT is a good tool to detect and follow up Dalen-Fuchs nodules.