Sympathetic ophthalmia following diode laser cyclophotocoagulation.
BACKGROUND
Sympathetic ophthalmia is a rare form of bilateral uveitis that develops following an ocular penetrating injury to one eye. Several cases of sympathetic ophthalmia have been reported after non-penetrating cyclodestructive procedures including Nd:YAG and diode laser cyclophotocoagulation (CPC) but information on inciting factors and outcome is limited. In this case series we investigated the inciting factors, clinical features, course and outcome of six patients who developed sympathetic ophthalmia after diode CPC.


METHODS
Six patients who developed sympathetic ophthalmia after diode CPC were identified from the King Khaled Eye Specialist Hospital uveitis database between 2008 and 2013. The medical records of these patients were reviewed for demographic information, ocular history, diode laser parameters, clinical presentation, treatment and outcome.


RESULTS
Six patients were diagnosed with sympathetic ophthalmia following treatment with diode laser CPC, an incidence of 0.001% during the study period. Two patients had a history of accidental trauma and all patients had undergone at least one ocular surgery that included a variety of procedures. At presentation, two patients had predominantly posterior segment findings in the sympathising eye, one patient had only anterior segment findings and the rest had panuveitis. All patients were treated with topical and systemic corticosteroids and/or immunosupressive therapy that resulted in complete resolution of inflammation and return to baseline vision in the sympathising eye within 2-48 months of treatment.


CONCLUSIONS
Sympathetic ophthalmia after diode CPC is rare and is seen in patients with a history of intraocular surgery with or without previous trauma. Early recognition of sympathetic ophthalmia and aggressive management with immunosuppressive therapy results in good outcomes for these patients.
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Abdullah
A
Albahlal
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Hassan
H
Al Dhibi
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Sami
S
Al Shahwan
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Rajiv
R
Khandekar
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Deepak P
DP
Edward
D000328:Adult; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D054023:Lasers, Semiconductor / Q000009:adverse effects*; D008028:Light Coagulation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009879:Ophthalmia, Sympathetic / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents
Choroid; Glaucoma; Immunology; Inflammation; Treatment Medical