玻璃体切割术致交感性眼炎

交感性眼炎在每10,000只常规手术眼中约有1眼发生,在每500只穿孔伤眼中有1眼发生。下述二部分调查可确定睫状体平部玻璃体切割术与交感性眼炎发生的关系,并评价行该手术的眼球发生交感性眼炎的危险性。第一部分调查得知在诊断为交感性眼炎而摘除的眼球中,后玻璃体切割术者所占的比例。这些眼球为1976～1980年间取自26处不同临床中心的病理实验室。组织学检查有交感性眼炎表现的20%眼中,曾有玻璃体切割手术史。在所有玻璃体     

眼球穿孔伴化脓性眼内炎导致的交感性眼炎

目的：总结分析眼球穿孔伴化脓性眼内炎导致的交感性眼炎的临床特征、诊断及可能的发病原因。方法：对1993-2002年本院收治交感性眼炎87例中伴有化脓性眼内炎病史的交感性眼炎3例患者的临床资料作回顾性分析总结。结果：1993-2002年本院收治的眼球穿通伤及眼球破裂伤的病人5253例，同期收治的交感性眼炎87例，交感性眼炎的发生率为1．65％。其中3例发病前有眼球穿孔合并化脓性眼内炎的病史，3例眼底荧光血管造影检查结果均符合交感性眼炎改变；1例组织病理学检查报告为典型交感性眼炎改变。结论：眼球穿孔伴化脓性眼内炎仍可能发生交感性眼炎，应引起注意。眼科学报2003；19：75-78     

交感性眼炎临床相关因素的分析

目的探讨发生交感性眼炎的相关因素。方法对75例交感性眼炎临床资料进行回顾性分析，包括性别、年龄、眼别、致伤原因、受伤部位、潜伏期及临床体征等。结果交感性眼炎多发生于青壮年，致伤原因多为眼球穿孔伤，占88．00％；受伤部位为角膜缘者最多，占59．32％；潜伏期9天～36年，以2～8周者最多，占47．89％；年龄越小发生后段改变的可能性越高，潜伏期在8周～1年的病例越趋向于发生后段改变。结论交感性眼炎的发生与年龄及受伤部位有关，后段改变较多发生于年龄小及潜伏期长者。     

交感性眼炎12例临床分析(摘要)

本文报告42例交感性眼炎的临床分析如下。一、交感性眼炎的发病率:10年共收住眼外伤627例,其中眼球穿通伤290例。交感性眼炎占眼外伤的1.91%,占眼球穿通伤的4.14%。锐器伤192例中7例发病占3.65%,钝器致眼球破裂74例有4例发病占5.41%,球内异物24例1例发病占4.17%,以眼球破裂所致的发病率最高。国内报导交感性眼炎发病率平均为2.08%,本院为4.14%,可能是就医不及时,处理不当等因素所致。     

交感性眼炎30例临床分析

目的探讨交感性眼炎的治疗及预防方法。方法回顾分析30例交感性眼炎的年龄、性别、致伤原因、受伤部位、潜伏期、发生率、临床表现、治疗及预后,讨论交感性眼炎发病机制、环磷酰胺疗效、摘除伤眼问题及预防方法。结果伤口24小时以内修复的眼球穿孔伤和同期内眼手术发生交感性眼炎22例,复发4例,复发率18.18%;伤口24小时以后修复及未修复的眼球穿孔伤发生交感性眼炎8例,复发4例,复发率50%。二者之间无显著差异(χ2=3.04 P>0.05)。交感性眼炎发生后再摘除伤眼者既不能缩短病程,也不能防止复发。应用皮质类固醇、环磷酰胺等药物治疗,炎症控制,视力均提高。结论及时准确处理伤眼及内眼手术可减少交感性眼炎的发生和复发,交感性眼炎发生后摘除伤眼要慎重选择适应证,联合应用环磷酰胺、皮质类固醇药物治疗效果较好。     

交感性眼炎的免疫治疗

交感性眼炎是恶性肿瘤以外最严重的眼病之一,其发病率国外统计占非手术性穿通伤的0.2～1、0％,国内统计占眼球穿通伤1～2％。交感性眼炎的发病机理尚未完全阐明,根据其临床表现,病理变化和实验室研究,现一般认为是对葡萄膜组织特异性抗原,视网膜可溶性抗原(S 抗原)的自身免疫性疾病,属于超敏反应。对于交感性眼炎的治疗,除了常规辅助     

关于交感性眼炎之商讨(摘要)

(一)交感性眼炎之发病率,各家报告差异极大。如:55％、3.29％、1％、1％、1.5/万,美军在越南战争时,未发现1例。 (二)以往交感性眼炎发病率的统计方法,“主要以临床诊断为依据、发病率一般指住院的交感性眼炎病例数和住院的眼球穿通伤总数的比例而言”。     

未治疗的眼球穿孔伤导致交感性眼炎三例临床分析

目的分析交感性眼炎3例的临床表现和治疗。方法对3例交感性眼炎临床表现和处理方法进行观察。结果1例眼球摘除。另2例炎症控制，保留眼球。结论及时处理伤眼减少交感性眼炎。已发生交感性眼炎者，在病程早期大利量皮质类同醇治疗，慎摘诱发眼。     

玻璃体切除术后交感性眼炎的临床分析

目的 分析玻璃体切除术后交感性眼炎的临床特征.方法 回顾性分析璃体切除术后交感性眼炎13例的临床资料.结果 发生交感性眼炎的时间距最后一次玻璃体手术时间为10 d～2年,4个月以内者8例（61.5％）,临床表现以视力下降为主,其次为眼痛、眼前黑影、视物变形.发病时交感眼视力为0.04 ～0.6,激发眼视力为无光感～数指.4例交感眼有渗出性视网膜脱离.所有患者经糖皮质激素治疗后交感眼和激发眼视力均有不同程度恢复.3例因激发眼视力完全丧失而行眼球摘除术.结论 玻璃体切除术后交感性眼炎发生率为0.29％;大多发生在手术后4个月以内;术中联合晶状体手术、巩膜外冷凝、术前存在眼外伤和其它手术史,增加发生交感性眼炎的危险.     

47例交感性眼炎激发眼临床资料分析

目的：探讨发生交感性眼炎的相关因素。方法：对47例交感性眼炎激发眼临床与病理资料进行回顾性分析，包括性别、年龄、眼别、致伤原因、受伤部位、潜伏期及病理改变等。结果：交感性眼炎多发生于青壮年，致伤原因多为眼球穿孔伤，受伤部位为角巩膜缘者最多，潜伏期在2～8周最多。病理改变以脉络膜从前向后的逐渐增厚为特征。结论：交感性眼炎的发生与年龄、受伤部位有关。交感性眼炎的病理学检查对交感性眼炎的诊断有指导意义。     

Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment

Introduction: Sympathetic ophthalmia, a diffuse bilateral granulomatous panuveitis, is a serious potential complication after penetrating eye injury. Many surgeons recommend enucleation within two weeks of trauma to prevent this condition. We retrospectively reviewed the medical records of patients with penetrating ocular injuries who had either evisceration or enucleation to determine the incidence of sympathetic ophthalmia and to evaluate the surgical interventions and their complications. Age at surgery, time after penetrating trauma, surgery technique, follow-up period, ophthalmic examination of the fellow eye, and surgical complications were evaluated. Results: In total, 217 patients were included in the study with a mean follow-up period of 10.3 ± 6.6 years. The longest time between the trauma and time of surgery was 43 years. Postoperative uveitis was observed in only one patient (0.5%) who had primary repair after injury. Histopathological review did not reveal typical sympathetic ophthalmia. Complications after enucleation were significantly higher than after evisceration. Conclusion: There was no histopathologically supported sympathetic ophthalmia in our series. Sympathetic ophthalmia is very rare even when the injured eye is retained. With this in mind, the first choice of treatment may not be enucleation. Furthermore, evisceration may be the procedure of choice if primary repair cannot be performed or for patients who have panophthalmitis.     

High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy.

BACKGROUND: Two cases of sympathetic ophthalmia occurring after noncontact neodymium:YAG (Nd:YAG) cyclotherapy have previously been reported. In each case, the patient had undergone filtering surgery in the exciting eye. Although in each case Nd:YAG cyclotherapy was the last surgery performed, the inciting event of sympathetic ophthalmia was unclear. METHODS: The authors studied three additional patients who developed sympathetic ophthalmia after Nd:YAG cyclotherapy for glaucoma. RESULTS: Two patients developed sympathetic ophthalmia 4 months after noncontact Nd:YAG cyclotherapy, and 1 patient developed sympathetic ophthalmia 18 months after contact Nd:YAG cyclotherapy. All patients had previous cataract extractions but no filtering surgery in the exciting eye. Clinical features included chronic iridocyclitis, choroidal folds, Dalen-Fuchs nodules, and optic disc edema. Combining these cases with the two previously reported cases, the incidence of sympathetic ophthalmia at our institution thus far is 5.8% (4 of 69) and 0.67% (1 of 150) after noncontact and contact Nd:YAG cyclotherapy, respectively. CONCLUSIONS: The incidence of sympathetic ophthalmia after Nd:YAG cyclotherapy is high compared with other ocular procedures. The clinician should vigilantly monitor patients after Nd:YAG cyclotherapy and report additional cases that may have occurred at other institutions.     

交感性眼炎52例临床分析

目的探讨交感性眼炎的发病机制、诊断及治疗方法。方法回顾性分析52例交感性眼炎的临床资料。结果交感性眼炎致伤物多种多样,眼球穿孔分别位于睫状区巩膜、角巩膜及角膜缘。病变部位以眼后段炎症为主者31例,占59．62％。外伤后发病时间最短15天,最长30年。人院时视力在0．1以下者32例,没有视力在1．0以上的病例,多数病人视力较差。经用糖皮质激素及免疫抑制剂治疗后视力恢复至0．2～0．9者14例,1．0及以上26例。视力存0．1以下者由32例减少至12例。视力较好和保留有用视力在0．2以上者共40例,占76．92％。结论穿孔性眼外伤可诱发交感性眼炎,尤其是眼球睫状区穿孔更为常见;用糖皮质激素或免疫抑制剂治疗本病取得了满意效果,说明交感性眼炎系自身免疫性疾病。     

Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent penetrating trauma

PURPOSE: To evaluate, describe, and categorize the clinical presentation, clinical course, histopathology, and response to therapy in patients without a history of penetrating ocular trauma who developed sympathetic ophthalmia following pars plana vitrectomy. METHODS: The records of patients without a history of trauma who underwent pars plana vitrectomy and developed sympathetic ophthalmia were retrospectively reviewed. Cases were analyzed with respect to clinical presentation, fluorescein angiographic findings, anatomic and visual outcomes, histopathology, and response to therapy. RESULTS: Eight eyes were identified. The median age at presentation was 55 years, with a range of 14 to 62 years. The time from vitrectomy to diagnosis of sympathetic ophthalmia ranged from 2 months to greater than 2 years, with a median of 7 months. Six of eight patients (75%) presented with anterior chamber reaction. All eight patients presented with a vitreous inflammatory response. The optic nerve was inflamed clinically or angiographically in four of eight cases (50%). Small yellow-white sub-retinal pigment epithelial deposits were present in four of eight cases (50%). Two eyes had lesions characterized as multifocal choroiditis. One eye had larger yellow placoid-like lesions. One eye presented with vitritis but no retinal lesions. Subretinal choroidal neovascularization was noted in the inciting eye of one patient. Vision improved in the sympathizing eye with immunosuppressive therapy in five of eight cases (62.5%). CONCLUSIONS: Sympathetic ophthalmia can be seen following pars plana vitrectomy in patients without penetrating injuries or a history of trauma. Indeed, it may be seen after successful vitrectomy for retinal detachment. Diverse clinical presentations are possible, and persistent or atypical uveitis following vitrectomy should alert the surgeon to the development of sympathetic ophthalmia.     

Changing trends in sympathetic ophthalmia

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following non-surgical penetrating injury to one eye. Three patients are presented where sympathetic ophthalmia developed after repeated vitreoretinal surgery. Prompt and effective management with systemic immunosuppressive agents permitted control of their disease and retention of good visual acuity in their remaining eye. Vitreoretinal surgery is an important risk factor in sympathetic ophthalmia. Informed consent for vitreoretinal surgery (especially in the re-operation setting) should now include the risk of sympathetic ophthalmia (approximately 1 in 800). Diverse clinical presentations are possible in sympathetic ophthalmia and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of sympathetic ophthalmia. Modern immunosuppressive therapy with systemic steroids and steroid-sparing agents such as cyclosporin A and azathioprine have improved the prognosis. This is particularly so in cases where early diagnosis is made and prompt and suitable immunotherapy is commenced.     

Laser photocoagulation for choroidal neovascularization associated with sympathetic ophthalmia

PURPOSE: To present a case of choroidal neovascularization associated with sympathetic ophthalmia successfully treated with photocoagulation. DESIGN: Interventional case report. METHODS: A 41-year-old man with a history of penetrating injury right eye, as well as sympathetic ophthalmia left eye, developed a classic choroidal neovascular membrane that threatened the center of the fovea. RESULTS: The patient was treated with argon laser photocoagulation. He has maintained stable visual acuity without evidence of recurrence of the membrane with 4 years' follow-up. CONCLUSION: Thermal laser should be considered as a treatment option in cases of choroidal neovascularization associated with sympathetic ophthalmia.     

Traumatic eye injuries due to large unusual foreign bodies: a Singapore case series

PURPOSE: Traumatic eye injuries due to large foreign bodies (FB) are rare. The visual prognosis is often poor in these cases because of severe ocular damage. Staged surgical procedures with eventual enucleation or evisceration are often indicated. METHODS: Case series. RESULTS: The authors describe two patients with eye injury due to large FB with visual acuity of no light perception at presentation. Both had initial repair of the ocular injuries and removal of the FB. One patient with an intraocular FB eventually underwent enucleation; the other, with intraorbital FB, had evisceration as a secondary procedure. Orbital implantations were done in both. Neither of the patients had developed sympathetic ophthalmia at the last review. CONCLUSIONS: The visual outcome of eye injuries due to large FB is poor. Both enucleation and evisceration can be performed with low risk of sympathetic ophthalmia. Prevention remains the best approach to such devastating injuries.     

Sympathetic ophthalmia, one missing disease?

Between 1992-1996 were treated ten cases with sympathetic ophthalmia, representing 0.16% from all hospitalized patients, in Ophthalmological Clinic from Craiova. The disease appeared after corneo-scleral penetrating wounds with membranes hernia at four cases; three from them was complications after cataract surgery and required long treatments; other two patients had glaucoma with closed angle in irreversible stages; another one presented herpetic cornea perforated ulceration with uveitis. Since ocular trauma until appearance of sympathetic ophthalmia, the time was two months at eight cases and two years at two cases. Under clinical aspect seven cases evolved like an anterior uveitis, two cases like a panuveitis and one like a uveopapillitis. Pathologic exam on the removed eye was not specific for sympathetic ophthalmia and only the clinical examination established the diagnosis. Under corticotherapy and immunomodulator therapy, sympathetic ophthalmia evolves this days benign. The disease should not be underestimated. It is not a disappeared disease..