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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 200-201

Sympathetic ophthalmia following therapeutic penetrating keratoplasty: A rare case report


1 Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
2 Cornea, Refractive Surgery and Eye Bank, Government Medical College and Hospital, Chandigarh, India

Date of Submission02-Jul-2020
Date of Acceptance10-Oct-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Sudesh Kumar Arya
Professor and Head of Cornea, Eye Bank and Refractive Surgery, Department of Ophthalmology, Government Medical College and Hospital, Sector-32 B, Chandigarh - 160030
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2112_20

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  Abstract 


Keywords: Sympathetic ophthalmia, therapeutic penetrating keratoplasty, panuveitis


How to cite this article:
Bhattacharyya A, Arya SK, Phulke S, Jha UP. Sympathetic ophthalmia following therapeutic penetrating keratoplasty: A rare case report. Indian J Ophthalmol Case Rep 2021;1:200-1

How to cite this URL:
Bhattacharyya A, Arya SK, Phulke S, Jha UP. Sympathetic ophthalmia following therapeutic penetrating keratoplasty: A rare case report. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 29];1:200-1. Available from: https://www.ijoreports.in/text.asp?2021/1/2/200/312358




  Case Report Top


A 37-year-old male patient presented with sudden painless deterioration of vision (20/400) along with metamorphopsia in his right eye. The patient underwent therapeutic penetrating keratoplasty three months back due to perforated corneal ulcer in left eye which resulted into a decompensated vascularized graft [Figure 1]a Anterior segment examination showed granulomatous anterior uveitis in right eye with associated retrolental flare [Figure 1]b. Dilated fundus examination showed optic disc hyperemia with patchy choroiditis lesions in posterior pole [Figure 2]a. Fundus fluorescein angiography (FFA) showed pinpoint leakage from corresponding lesions in late phase [Figure 2]b, [Figure 2]c. Ultrasound B-scan showed increased retinochoroidal thickness in right eye [Figure 2]d and spectral-domain optical coherence tomography (SD-OCT) showed serous retinal detachment corresponding the lesion [Figure 3]a The patient was managed conservatively with pulse steroids for three days followed by oral steroids in tapering doses along with continued topical steroids. Three months follow-up showed improvement of BCVA to 20/25 with development of posterior sub capsular cataract [Figure 1]c. SD-OCT in subsequent follow up visit showed resorption of serous fluid [Figure 3]b with complete resorption at 3 month follow up visit [Figure 3]c along with development of epi-retinal membrane in macular area as late sequelae. USG-Bscan showed decrease of retinochoroidal thickness in 3 month follow up visit [Figure 2]e as compared to the day of presentation [Figure 2]d.
Figure 1: Slit-lamp image of both left and right eye. (a) Decompensated vascularized corneal graft (Left eye); (b) pigmented Kps (Blue arrow) and pigments over anterior lens capsule (white arrow) in right eye; (c) posterior sub capsular cataract (white arrow, right eye)

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Figure 2: Fundus image (Color and FFA image) and USG-B scan of right eye: (a) Color fundus image showing blurred optic disc margin with disc hyperemia with multiple choroidal lesions at the posterior pole; (b) Fundus fluorescein image shows corresponding lesions as depicted by early hyper fluorescence; (c) Late phase FFA shows pinpoint leakage; (d) Increased retino-choroidal thickness on the day of presentation seen on USG-B scan; 2(e) Subsequent reduced retino-choroidal thickness at 3rd month follow up visit

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Figure 3: SD-OCT image: (a) Neurosensory RD with sub-retinal fluid accumulation (red arrow, (b) 1 week follow up image shows partial resorption of sub retinal fluid, (c) three months follow up image showed complete resorption of sub-retinal fluid with formation of epi retinal membrane

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  Discussion Top


Sympathetic ophthalmia (SO) is a rare, granulomatous panuveitis etiopathology being hypothesized to be the autoimmune response to own tissue as antigen.[1] Very few case reports have been reported in the literature documenting SO following penetrating keratoplasty[1],[2] in which crystalline lens extrusion and vitreous loss may be the probable exciting factor. Diagnosis is usually clinical and investigations are useful adjunctive tools in establishing the diagnosis and to follow the disease course.[3],[4] Systemic immunosuppression (oral/intravenous corticosteroids or other immunosuppressive agents) is the mainstay of treatment and disease usually follows course of recurrent episodes while most patients maintains functional vision.[5] In our patient, timely diagnosis and prompt initiation of systemic immunosuppression (systemic and topical corticosteroids) lead to early resolution of signs and symptoms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mahajan S, Invernizzi A, Agrawal R, Biswas J, Rao NA, Gupta V. Multimodal imaging in sympathetic ophthalmia. Ocul Immunol Inflamm 2017;25:152-9.  Back to cited text no. 1
    
2.
Yamaguchi Y, Otani T, Kishi S. Tomographic features of serous retinal detachment with multilobular dye pooling in acute Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2007;144:260-5.  Back to cited text no. 2
    
3.
Mahajan S, Invernizzi A, Agrawal R, Biswas J, Rao NA, Gupta V. Multimodal imaging in sympathetic ophthalmia. Ocul Immunol Inflamm 2017;25:152-9.  Back to cited text no. 3
    
4.
Rao NA. Mechanisms of inflammatory response in sympathetic ophthalmia and VKH syndrome. Eye (Lond) 1997;11:213-6.  Back to cited text no. 4
    
5.
Galor A, Davis JL, Flynn HW, Feuer WJ, Dubovy SR, Setlur V, et al. Sympathetic ophthalmia: Incidence of ocular complications and vision loss in the sympathizing eye. Am J Ophthalmol 2009;148:704-10.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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