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Sympathetic ophthalmia still possible, but treatable
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ROME — The prognosis for sympathetic ophthalmia is much better than in past years, according to one physician. Although this is a rare condition, it may still occur in some patients following trauma or surgery.
“The incidence of sympathetic ophthalmia has grown so little over the years that most young ophthalmologists have only read about it in old text books. In those days, it had a notorious reputation of being a severe chronic condition and producing a progressive deterioration of vision,” Mahmoud M. Soliman, MD, said at the International Society of Ocular Trauma meeting.
Newer drugs and improved surgical techniques have helped physicians control sympathetic ophthalmia more successfully, oftentimes preserving vision. In a minority of genetically predisposed patients, sympathetic ophthalmia develops in the contralateral eye as a result of trauma. Stimulating the immune system against a particular protein triggers the reaction, Dr. Soliman said.
Inflammation can take the form of exudative retinal detachment or of an insidious chronic granulomatous reaction, ending in some severe complications. Often, rather than the inflammation itself, the first symptoms are the sequelae of inflammation, such as cataract and glaucoma.
Dr. Soliman said the prevalence is very low. “In the U.K., it was found to be 3 out of 10 million post-surgery cases. The incidence is probably higher following trauma,” although probably still less than the 0.1% to 0.2% rate estimated in previous years, he said.
Surgeons should not ignore the various aspects of the condition, however, he said.
“This disease can be a consequence of surgical procedures. We should be aware of it. Second, sympathetic ophthalmia is not as fearful as it used to be, and can now be controlled successfully,” he said.