SYMPATHETIC OPHTHALMIA: Clinicopathologic Correlation in a Consecutive Case Series

Retina. 2015 Aug;35(8):1696-703. doi: 10.1097/IAE.0000000000000506.

Abstract

Purpose: To correlate the clinical course of sympathetic ophthalmia with the histological and immunohistochemical characteristics of the enucleated inciting eye.

Methods: A consecutive case series with baseline clinical features and subsequent histopathologic findings.

Results: Evaluation of the 16 enucleated inciting eyes (blind and painful) disclosed that 9 of the 16 had typical histology, fulfilling the criteria for sympathetic ophthalmia of diffuse granulomatous inflammation. Among the 16, 11 sustained previous penetrating trauma, 4 underwent previous eye surgery, and 1 patient presented with an unknown etiology. Patients with atypical histology (7 of 7) were taking corticosteroids at the time of enucleation. Only 2 of 9 patients with typical histology were taking corticosteroids at the time of enucleation. At 6 months after enucleation of the inciting eye, 4 of the 7 patients with atypical histology had a visual acuity of ≥20/40 compared with 8 of 8 patients (100%) with typical histology. On a 4-point scale (0-3+), the choroidal infiltrate of the 9 histopathologically typical eyes showed an average of 2.5+ CD68 (macrophages), 2.5+ CD20 (B cells), and 1.5+ CD3 (T cells).

Conclusion: Histopathologic findings had minimal correlation with the clinical course of sympathetic ophthalmia. Corticosteroid treatment before enucleation may influence the pathologic confirmation of sympathetic ophthalmia. The predominance of B lymphocytes and macrophages over T lymphocytes may represent different stages of the disease process.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / metabolism
  • Cell Lineage
  • Child
  • Choroiditis / pathology*
  • Eosinophils / pathology*
  • Eye Enucleation
  • Female
  • Fluorescein Angiography
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Ophthalmia, Sympathetic / diagnosis*
  • Ophthalmia, Sympathetic / etiology
  • Ophthalmia, Sympathetic / metabolism
  • Risk Factors
  • Scleritis / pathology*
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Biomarkers
  • Glucocorticoids
  • Immunosuppressive Agents