STEROID PULSE THERAPY IN SEVERE SYMPATHETIC OPHTHALMITIS – A CASE SERIES OF 4 PATIENTS

Sympathetic ophthalmitis (SO) is a rare bilateral, granulomatous uveitis that occurs following surgical or accidental trauma to one eye. Injured eye is the Exciting eye and the fellow eye is the Sympathizing eye. Most accepted patho-physiology is immune mediated. In this series, 4 patients with varied presentations were started on steroid pulse therapy (SPT) following routine blood investigation. 1 gram i.v methyl-prednisolone was given on 3 consecutive days in 300 ml Normal Saline under close observation. The patients were then shifted to oral steroid which was gradually tapered over 11 days. The patients were followed up for a minimum period of 14 days and the visual outcome was recorded.

Epidemiology of 2000 Chinese uveitis patients from Northeast China

AimsTo study the clinical characteristics of 2000 patients with uveitis admitted to the ophthalmology centre of the Second Hospital of Jilin University.MethodsWe retrospectively analysed 2000 patients with uveitis who were admitted to the uveitis clinic of the Second Hospital of Jilin University from July 2010 to June 2019 and analysed data on sex, onset age, onset season, anatomical classification, visual acuity and compared the results with those of other investigation studies.ResultsAmong 2000 uveitis patients, the mean age of onset was 39.9±14.9 years. There were 946 male patients (47.3%) and 1054 female patients (52.7%). By anatomical classification, panuveitis was the most common (986 cases, 49.3%), followed by anterior uveitis (786 cases, 39.3%), posterior uveitis (119 cases, 6.0%) and intermediate uveitis (109 cases, 5.5%). Among anterior uveitis cases, ankylose spondylitis (207 cases, 26.34%), Fuchs syndrome (74 cases, 9.41%) and viral uveitis (71 cases, 9.03%) were the most common. Among panuveitis cases, Vogt-Koyanagi-Harada syndrome (372 cases, 37.73%), Behcet’s disease (142 cases, 14.40%) and sympathetic ophthalmitis (33 cases, 3.35%) were the most common. Uveitis often occurs during the autumn–winter transition period. The prevalence of anterior uveitis is highest in November, and statistical analysis shows that the incidence of uveitis has a significant correlation with the month. Panuveitis has the most significant effect on vision.ConclusionPanuveitis and anterior uveitis are the most common anatomical classifications of uveitis, which has a significant impact on vision, and their incidence is related to seasonal changes.

Sympathetic ophthalmitis: A rare case presentation

Sympathetic Ophthalmitis is a rare, granulomatous uveitis occurring after perforating eye injury or ocular surgical procedure to one eye. The pathophysiologyis not clearly understood. We report a rare case of sympathetic ophthalmitis that presented to us in our hospital.Journal of Kathmandu Medical College, Vol. 4, No. 2, Issue 12, Apr.-Jun., 2015 page: 65-67

Cyclosporine-Associated Leukoencephalopathy in a Case of Sympathetic Ophthalmitis

Purpose: Cyclosporine (CsA) is currently widely used as a primary immunosuppressive agent in ocular disease, particularly in severe uveitis. Posterior reversible encephalopathy syndrome (PRES) is a significant complication of CsA therapy. However, there are no reports of the occurrence of PRES in response to the treatment of uveitis in the ophthalmological area. Case Presentation: We report a case with CsA-associated PRES. A 70-year-old woman with sympathetic ophthalmitis was treated with 50 mg/day of CsA for 1 week. However, the trough level in her blood was too low; thus, we increased the dose to 100 mg/day of CsA with prednisolone. She had headaches, hypertension (systolic blood pressure 180-200 mm Hg), loss of consciousness for several hours, and reduced limb movement, and her MRI showed a high signal intensity in both posterior lobes, consistent with PRES. Examination of the cerebrospinal fluid indicated that it was within normal limits. Her CsA trough level in the blood was within normal ranges on the day of the attack. Her symptoms gradually improved over the next several days; however, she presented with cortical blindness, which lasted for several weeks. Finally, she returned to her baseline values from before the attack. Her MRI findings showed that PRES had essentially disappeared. Conclusion: PRES is not directly associated with the dosage of CsA administered; however, in general, it is well known that PRES can affect strongly immunosuppressed cases undergoing organ and bone marrow transplantation. Nevertheless, our CsA dose was only 100 mg (1.8 mg/kg). In this study, we report on the occurrence of PRES after the administration of CsA to treat sympathetic ophthalmia. To our knowledge, PRES can also occur after the administration of a small dose of CsA; thus, ophthalmologists using CsA should carefully observe the systemic conditions of CsA-treated patients.

Autoimmune eye disease

Overview Uveitis Tubulointerstitial nephritis and uveitis (TINU) Vogt–Koyanagi–Harada disease (VKH) Cancer-associated retinopathy and uveitis Birdshot retinopathy Scleritis Ocular cicatricial pemphigoid Sympathetic ophthalmitis Idiopathic orbital inflammation (orbital pseudo-tumour) The eye has a number of interesting immunological properties which alter the propensity for immune-mediated disease, including the curious feature that antigen injected into the anterior chamber induces tolerance rather than immunity. In addition, the eye has no true lymphatics, relatively poor vascularity, and, as the retina is an extension of the CNS, there is a blood–retinal barrier which limits passage of molecules in either direction. Ocular involvement is a common feature of many connective tissue and vasculitic diseases....