Sympathetic ophthalmia following postoperative bacterial endophthalmitis: a clinicopathologic study.
OBJECTIVE
Clinical and histopathologic documentation of sympathetic ophthalmia (SO) development in eyes with postoperative bacterial endophthalmitis.


METHODS
Observational case series; retrospective clinicopathologic study.


METHODS
All patients who presented with a clinical diagnosis of SO during 2002 to 2004 were included in the study. The diagnosis of SO was made on the basis of history of penetrating ocular injury, followed by development of bilateral intraocular inflammation, ultrasonographic detection of bilateral diffuse thickening of the choroid, or both. Patients presenting with the additional finding of hypopyon underwent an anterior chamber tap and vitreous aspirate for microbiologic detection of bacteria and fungi. Eight exciting eyes were enucleated and submitted for histologic examination.


RESULTS
Of a total of 26 patients with a clinical diagnosis of SO, four also had bacterial endophthalmitis. Of these, histologic examination of three exciting eyes revealed vitreous abscess and typical features of SO. Of the five remaining enucleated globes, histologic examination showed that two eyes had phacoanaphylactic endophthalmitis, and two others revealed features of SO; the one remaining eye had nongranulomatous diffuse choroiditis.


CONCLUSIONS
Bacterial endophthalmitis cannot prevent the development of SO. Early diagnosis of coexistent mixed infectious and inflammatory processes, and initiation of antimicrobial treatment directed at the infection followed by immunomodulatory agents to address the autoimmune component may improve the prognosis in such cases.
Rathinam
Sivakumar R
SR
Uveitis Service, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Aravind Medical Research Foundation, 1 Anna Nagar, Madurai, Tamil Nadu 625-020, India. rathinam@aravind.org
Rao
Narsing A
NA
D000038:Abscess / Q000382:microbiology; D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000382:microbiology; D002387:Cataract Extraction; D002648:Child; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000628:therapy; D015807:Eye Injuries, Penetrating / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009879:Ophthalmia, Sympathetic / Q000175:diagnosis* / Q000188:drug therapy; D011183:Postoperative Complications; D014822:Vitreous Body / Q000382:microbiology
D005938:Glucocorticoids