Hellmund K, Frühauf A, Seiler T, Naumann G O
Augenklinik im Universitätsklinikum C. G. Carus, TU Dresden.
Klin Monbl Augenheilkd. 1998 Sep;213(3):182-5. doi: 10.1055/s-2008-1034970.
Sympathetic ophthalmia is a rare form of autoimmune uveitis and manifests in 90% of cases within the first year after penetrating injuries or surgical interventions.
In the present case the sympathetic ophthalmia started 50 years after a penetrating injury by a shell splinter. The injured eye was amaurotic and phthitic and the sympathizing eye showed an anterior uveitis. After an initial treatment with local and systemic corticosteroids the uveitis improved. The clinical diagnosis of sympathetic ophthalmia was made after a second inflammation course with substantial visual loss and subtotal chorioidal detachment. After enucleation of the exciting eye the diagnosis was confirmed by histological examination. An immunosuppressive therapy including azathioprine and cyclosporine became necessary to control the uveitis.
After enucleation the corticosteroid treatment was not sufficient. Additional therapy with azathioprine resulted in a recovery of the symptoms but had to be stopped because of adverse reactions. The alternative therapy by means of cyclosporine was tolerated well, but dose reduction was difficult because of recurrences. After a 30 month lasting cyclosporine therapy the patient shows stabile results since 6 months with visual acuity of 20/30.
The present case report demonstrates that a delayed onset of sympathetic ophthalmia 50 years after initial trauma may occur but can be controlled by an immediate, high dose immunotherapy.
交感性眼炎是一种罕见的自身免疫性葡萄膜炎，90%的病例在穿透性损伤或手术干预后的第一年内出现症状。
在本病例中，交感性眼炎在炮弹碎片穿透伤50年后发病。受伤眼失明且眼球痨，交感眼表现为前葡萄膜炎。经局部和全身使用皮质类固醇进行初始治疗后，葡萄膜炎有所改善。在出现第二次炎症发作且视力严重丧失和脉络膜部分脱离后，做出了交感性眼炎的临床诊断。摘除激发眼后，通过组织学检查证实了诊断。为控制葡萄膜炎，有必要进行包括硫唑嘌呤和环孢素在内的免疫抑制治疗。
摘除激发眼后，皮质类固醇治疗并不充分。加用硫唑嘌呤治疗后症状有所缓解，但因不良反应不得不停药。改用环孢素治疗耐受性良好，但因病情复发难以减量。经过30个月的环孢素治疗，患者自6个月以来视力稳定在20/30。
本病例报告表明，初始创伤50年后交感性眼炎可能延迟发病，但可通过立即进行高剂量免疫治疗加以控制。
