Takai Yasuyuki, Sakanishi Yoshihito, Okamoto Masahiro, Ebihara Nobuyuki
Department of Ophthalmology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu City, Chiba, 279-0021, Japan.
BMC Ophthalmol. 2021 May 2;21(1):195. doi: 10.1186/s12886-021-01961-z.
Sympathetic ophthalmia (SO) is a bilateral diffuse uveitis that can arise after ocular trauma or ocular surgery in the inciting eye. Pars plana vitrectomy (PPV) is one of the risk factors for SO. Several reports have described SO developing after 23- and 25-G PPV, but none have described SO occurring after 27-G PPV. We describe herein a case of SO after 27-G PPV for rhegmatogenous retinal detachment.
A 42-year-old woman presented with visual disturbance in the right eye. Best-corrected visual acuity (BCVA) was 6/200 in the right eye. Fundus examination revealed off-macula retinal detachment with retinal tears at both ends of retinal lattice degeneration at the temporal-oven peripheral retina of the right eye. We therefore performed 27-G sutureless PPV on the right eye. After 12 days, the retina was reattached, and BCVA improved to 6/30 in the right eye. Fifteen days postoperatively, she experienced headache and reduced vision in both eyes. Symptoms gradually worsened, and she visited our hospital 21 days postoperatively. BCVA was 6/30 in the right eye and 6/15 in the left eye. Slit-lamp examination revealed uveitis in the anterior chambers of both eyes, and fundus examination showed papillitis and subretinal detachment at the posterior poles of both eyes. Optical coherence tomography revealed subretinal fluid in the maculae of both eyes and fluorescein angiography showed multiple hyperfluorescent leakage sites in the retinal pigment epithelium. Cerebrospinal fluid examination showed pleocytosis and human leukocyte antigen testing showed expression of the DR04 phenotype; therefore, the patient was diagnosed with SO. She was treated with steroid therapy, and her visual disturbance subsided and the subretinal fluid improved as well. Her BCVA was 6/15 for the right eye and 6/5 for the left eye 93 days after the initial surgery.
The present case shows that even if the sclerotomy site of 27-G PPV is small, there is still a risk of SO occurring in the eyes of patients who underwent transconjunctival vitrectomy. Ophthalmologists should recognize SO as complication of 27-G PPV and carry out proper management as early as possible.
交感性眼炎（SO）是一种双侧弥漫性葡萄膜炎，可发生于激发眼遭受眼外伤或眼手术后。玻璃体切割术（PPV）是SO的危险因素之一。有几份报告描述了23G和25G PPV后发生SO的情况，但尚无27G PPV后发生SO的报道。我们在此描述一例因孔源性视网膜脱离行27G PPV后发生SO的病例。
一名42岁女性因右眼视力障碍就诊。右眼最佳矫正视力（BCVA）为6/200。眼底检查发现右眼颞侧周边视网膜格子样变性两端有视网膜裂孔伴黄斑外视网膜脱离。因此，我们对右眼进行了27G无缝线PPV。12天后，视网膜复位，右眼BCVA提高到6/30。术后15天，她出现头痛和双眼视力下降。症状逐渐加重，术后21天来我院就诊。右眼BCVA为6/30，左眼为6/15。裂隙灯检查发现双眼前房有葡萄膜炎，眼底检查显示双眼后极部有视乳头炎和视网膜下脱离。光学相干断层扫描显示双眼黄斑区有视网膜下液，荧光素血管造影显示视网膜色素上皮有多个高荧光渗漏点。脑脊液检查显示细胞增多，人类白细胞抗原检测显示DR04表型表达；因此，该患者被诊断为SO。她接受了类固醇治疗，视力障碍消退，视网膜下液也有所改善。初次手术后93天，她的右眼BCVA为6/15，左眼为6/5。
本病例表明，即使27G PPV的巩膜切口小，经结膜玻璃体切割术患者的眼睛仍有发生SO的风险。眼科医生应认识到SO是27G PPV的并发症，并尽早进行适当处理。
