SYMPATHETIC OPHTHALMIA: Clinicopathologic Correlation in a Consecutive Case Series

• Published in: Retina (Philadelphia, Pa.) Vol. 35; no. 8; pp. 1696 - 1703
• Main Authors: Aziz, Hassan A, Flynn, Jr, Harry W, Young, Ryan C, Davis, Janet L, Dubovy, Sander R
• Format: Journal Article
• Language: English
• Published: United States 01-08-2015
• Subjects: 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
• ISSN: 0275-004X; 1539-2864
• DOI: 10.1097/IAE.0000000000000506

To correlate the clinical course of sympathetic ophthalmia with the histological and immunohistochemical characteristics of the enucleated inciting eye.
A consecutive case series with baseline clinical features and subsequent histopathologic findings.
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).
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.