Tyagi Mudit, Agarwal Komal, Reddy Pappuru Rajeev R, Dedhia Chintan, Agarwal Hitesh, Nayak Sameera, Panchal Bhavik, Kaza Hrishikesh, Basu Soumyava, Pathengay Avinash, Murthy Somasheila, Sangwan Virender S
a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India.
b Uveitis and Retina services, KVC Campus , L.V. Prasad Eye Institute , Vijayawada , India.
Semin Ophthalmol. 2019;34(3):157-162. doi: 10.1080/08820538.2019.1610464. Epub 2019 May 5.
To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes. 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia.
为评估在玻璃体视网膜手术后发生交感性眼炎（SO）且无穿透性眼外伤史患者的临床表现、病程及预后，对所有诊断为交感性眼炎并接受治疗的患者临床记录进行回顾性分析。纳入所有既往无外伤史的病例，并对其临床表现、解剖及视觉预后进行分析。截至2017年6月，共诊断并治疗了175例交感性眼炎患者。其中16例过去曾接受过玻璃体切割术（PPV）且无眼部外伤史。玻璃体视网膜手术后发生的交感性眼炎占所有交感性眼炎病例的9.14%。在同一时期，截至2017年，共进行了41365例PPV。因此，PPV病例中0.038%发生了交感性眼炎。男性患者10例，女性患者6例。发病时的中位年龄为45.7岁。从手术到诊断为交感性眼炎的时间间隔为术后22天至4年。交感眼的平均视力为1.26 logMAR（相当于Snellen视力表的20/320），治疗后提高到0.62 logMAR（相当于Snellen视力表的20/80）。最常见的前段表现是非肉芽肿性前葡萄膜炎，见于8例（50%），而神经感觉脱离是最常见的后段表现（10例，62.5%）。12例患者接受了不止1次手术（平均手术次数为1.88次）。10例患者接受了无缝线PPV（6例23G和4例25G玻璃体切除术），4例患者接受了20G玻璃体切除术，术后所有巩膜切口均缝合。所有患者均接受全身类固醇和免疫抑制剂治疗，16例患者中有15例交感眼的最终视力有显著改善。玻璃体视网膜手术后的交感性眼炎是一种罕见但可能威胁视力的疾病，在所有玻璃体切割术病例中占0.038%。一只眼进行玻璃体视网膜手术后，另一只眼出现炎症应提醒外科医生警惕交感性眼炎的可能性。
