眼内炎50年后发生交感性眼炎一例

交感性眼炎的发病率国外统计占非手术性穿通伤的0.2～1％,国内统计占眼穿通伤的1～2％。交感性眼炎的潜伏期,最短的为10天;最长达40年。近来有人统计61％的病人发生在受伤眼后的3周～2个月之间,90％发生在1年之内。我们在1988年收治1例潜伏期达50年之久,现报告如下:     

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。     

交感性眼炎

我院自1957年6月至1994年3月,37年间共收治交感性眼炎5例,占眼球穿孔伤住院病例的0.38%.其中1例伤眼化脓后发生交感性眼炎,采用发热疗法治愈,3例皮质类固醇疗程后加用发热疗法,病情稳定,随访2～18年,未见复发.一般资料:男4例,女1例,年龄20～36岁,右眼3例,左眼2例.金属异物致眼穿孔伤4例,拳击致眼球破裂伤1例.潜伏期短者22天,长者56天,眼前段病型1例,眼后段病型3例,全葡萄膜病型1例.伤后8天摘除化脓性伤眼1例,发生交感性眼炎后摘除刺激眼2例(病理证实),保留刺激眼2例.     

眼球穿孔伤致交感性眼炎一例

1 病例 患者女,40岁.因左眼球穿孔伤缝合术后1个月于2011年11月16日入院. 患者1个月前左眼被树枝戳伤,当时眼痛明显,视力丧失,伤后就诊于安庆市某医院,诊断为“左眼角巩膜穿孔伤、左眼玻璃体积血”,急诊行“左眼球裂伤缝合术”.术后给予抗炎止血对症治疗,告知患者出院后定期复查,2周后至上级医院行玻璃体切除手术.患者于2011年11月14来我院就诊,要求行左眼手术以提高视力.入院查体：视力：右0.4,矫正1.0;左光感.眼压：右13 mm Hg,左9 mmHg（1mmHg =0.133 kPa）.双眼睑正常,双侧泪道冲洗通畅,按压泪囊区无脓液流出.右眼结膜无充血,角膜透明,角膜后沉着物（-）.     

眼球穿通伤未处理致交感性眼炎1例

患者 ,男 ,2 8岁。 7周前左眼被酒瓶划伤 ,当即到某医院就诊 ,诊断为“左眼球破裂伤”,但未给予及时缝合处理 ,伤口自行闭合且失明。于 30多天后 ,右眼感视物模糊、流泪、复视 ,考虑为“交感性眼炎”收入我院。眼科检查 :右眼视力 0 .5 ,球结膜无充血 ,角膜透明 ,房水闪辉 (+) ,瞳孔等大等圆 ,对光反射正常 ,眼底可见视乳头色红 ,边界欠清 ,以视乳头为中心有放射状皱褶 ,视网膜反光增强 ,黄斑中心凹光反射消失。左眼无光感 ,结膜混合充血 ,无前房 ,角膜 1点至 5点半区可见一纵形贯通伤 ,伤口波及巩膜长约 14mm ,脱出虹膜嵌顿于伤口处 ,并被…     

眼球穿孔伤致化脓性眼内炎治疗失败原因分析

目的 探讨眼球穿孔伤所致化脓性眼内炎治疗失败的原因。方法 小儿因眼球穿孔伤致化脓性眼内炎23例，伤后经5—17天药物治疗无效后转手术治疗。术前视力光感—数指，前房渗出、积脓及玻璃体积脓。所有病例均行玻璃体切除手术。术后继续抗生素和皮质类固醇药物治疗，随访3—8周。结果 手术中见所有病例在锯齿缘处有厚密的奶油样脓液，因粘连紧密无法完全切除。3例发生医源性视网膜裂孔，采用硅油填充术。20例术后发生视网膜脱离，8例再次接受手术治疗。14例玻璃体培养为阴性结果。术后眼内炎控制，但因视网膜脱离最终全部术眼眼球萎缩。结论 眼球穿孔伤所致化脓性眼内炎，一旦锯齿缘出现难以清除的奶油样脓液，治疗极为困难且预后极差。     

角膜溃疡穿孔诱发交感性眼炎：附3例报告

本文报告角膜溃疡穿孔诱发交感性眼炎3例。年龄30～60岁,潜伏期为1个月至30年。3例刺激眼均摘除眼球送病理检查而确诊。全身及局部使用皮质类同醇治疗后。3例病人均保存了一定视力。结合本文病例对交感性眼炎的发病机理进行了讨论。并提出对于一眼曾发生角膜溃疡穿孔,对侧眼发生葡萄膜炎,应考虑到交感性眼炎的可能。如刺激眼已丧失视功能,应摘除眼球作病理检查以确诊。     

大鼠眼内异物伤诱发交感性眼炎的实验研究

目的观察大鼠单侧眼外伤能否诱发交感性眼炎,为交感性眼炎的发病机制提供理论依据。方法将36只Wistar健康成年大鼠随机分为Ⅰ组眼内异物（砂粒）伤组、Ⅱ组异物（刀片）伤组、Ⅲ组正常对照组。正常对照组大鼠4只,不做任何处理。Ⅰ组、Ⅱ组中各16只大鼠右眼为异物植入眼,将不同异物经睫状体部位置入玻璃体腔,获得大鼠单眼异物伤型,通过额带放大镜观察双眼前段变化,并于2、4、6、8周摘除眼球,应用HE染色观察双眼球的组织病理学变化。结果Ⅰ组、Ⅱ组大鼠右眼眼前段主要表现为球结膜充血、水肿,创口处有异常分泌物,眼球萎缩随时间延长例数增加。组织病理学可见中性粒细胞、淋巴细胞浸润。左眼无眼前段变化及组织病理学变化。Ⅲ组未见病理性改变。所有外伤眼均未能诱发交感性眼炎。结论交感性眼炎的发病机制复杂,通过单纯模拟交感性眼炎的易发条件未能诱发出交感性眼炎。     

外伤性眼内炎对眼免疫赦免状态的影响

目的研究外伤后眼内炎症对眼免疫赦免状态的影响。方法在Ｗｉｓｔａｒ大鼠和新西兰白兔建立外伤性眼内炎模型。将牛血清白蛋白分别接种于受伤眼和正常眼玻璃体腔。接受附加佐剂的牛血清白蛋白免疫方案１周后,评价其诱导玻璃体腔相关免疫偏离的能力,并观察受伤眼组织病理学改变。结果眼外伤后５～７天发生中度到重度炎症反应。常规免疫组动物均出现抗原特异性迟发型超敏反应（ＤＴＨ）阳性;单纯玻璃体腔抗原接种组动物均显示ＤＴＨ阴性;受伤眼玻璃体腔抗原接种组和受伤眼玻璃体抗原接种后对侧正常眼玻璃体抗原接种组均显示ＤＴＨ阳性。结论外伤性眼内炎导致受伤眼和正常眼免疫偏离诱导的失败。眼相关免疫偏离的消失可能参与了交感性眼炎的发病过程。     

Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.     

Sympathetic Ophthalmia

Sympathetic ophthalmia is a rare, bilateral granulomatous uveitis that occurs after either surgical or accidental trauma to one eye. The ocular inflammation in the fellow eye becomes apparent usually within 3 months after injury. Clinical presentation is an insidious or acute anterior uveitis with mutton-fat keratic precipitates. The posterior segment manifests moderate to severe vitritis, usually accompanied by multiple yellowish-white choroidal lesions. Evidence suggests that sympathetic ophthalmia represents an autoimmune inflammatory response against choroidal melanocytes mediated by T cells. Diagnosis is based on clinical findings and a history of previous ocular trauma or surgery. Other causes of granulomatous uveitis, such as Vogt-Koyanagi-Harada disease, sarcoidosis, tuberculosis, and syphilis should be considered. Treatment of sympathetic ophthalmia consists of systemic anti-inflammatory agents with high dose oral corticosteroid as the drug of choice. However, if the inflammation cannot be controlled, cyclosporine is then used. Other immunosuppressive agents, such as chlorambucil, cyclophosphamide or azathioprine, may be necessary for the control of inflammation. The role of enucleation after the diagnosis of sympathetic ophthalmia remains controversial. Visual prognosis is reasonably good with prompt wound repair and appropriate immunomodulatory therapy.     

Thirty-year History of Sympathetic Ophthalmia

A spontaneous corneal perforation followed by granulomatous uveitis occurred in a 10-month-old female infant with bilateral anterior segment anomalies. The histopathologic findings in the enucleated right eye and the 30-year course of intraocular inflammation in her left eye are consistent with sympathetic ophthalmia. This case illustrates that sympathetic ophthalmia can be overlooked for years unless the diagnosis is considered and periodic anterior segment biomicroscopy and indirect ophthalmoscopy are performed in patients who have had perforating ocular injuries. A lensectomy-vitrectomy procedure was successful in restoring ambulatory vision in this patient.     

Lymphocytic Meningitis in Patients with Sympathetic Ophthalmia

Purpose: This study aimed at reporting lymphocytic meningitis in patients diagnosed with sympathetic ophthalmia (SO).

Methods: In this single-center retrospective observational case series, we reviewed cases diagnosed with SO. We analyzed the patients’ inciting injuries, the characteristics of uveitis and the cerebrospinal fluid (CSF) analyses.

Results: Nine patients were diagnosed with SO and CSF analyses were available in all cases. Four cases had lymphocytic pleocytosis, 3 of which showed marked CSF inflammation with more than 300 lymphocytes/mm³. The inciting event in these 3 patients was a globe perforation injury, whereas 4 patients without meningitis had SO following a surgical intervention.

Conclusions: In this case series of patients with SO, lymphocytic meningitis was a common finding. The prevalence of meningitis in patients with SO and its value for the diagnosis of the disease needs to be further studied.     

Multimodal Imaging in Sympathetic Ophthalmia

Purpose: To show the current status of multimodal imaging and its role in supporting an early diagnosis of sympathetic ophthalmia.

Methods: The diagnosis is mainly clinical supported with ancillary investigations; mainly fluorescein angiography and others, including indocyanine angiography optical coherence tomography (OCT), OCT enhanced depth imaging, autofluorescence imaging, and ultrasonography.

Results: Various imaging modalities such as OCT, autofluorescence imaging and angiography are critical in the diagnosis and management of sympathetic ophthalmia. The clinician must make adequate use of such ancillary investigations in the management of the patients.

Conclusions: Sympathetic ophthalmia is a rare, bilateral inflammation of the uveal tract following penetrating trauma or surgery in one eye. The intraocular inflammation requires a prompt diagnosis so that the treatment can be initiated as early as possible.     

Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence,Clinical Presentations and Outcomes of a Rare Disease

Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries

Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes.

Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye

Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia     

The Role of Perivascular Melanophage Infiltrates in the Conjunctiva in Sympathetic Ophthalmia

Purpose: To report pathologic changes in the conjunctiva from the exciting eye in a case of sympathetic ophthalmia (SO).

Methods: Report of clinical findings and conjunctival histopathology in a patient with SO.

Results: A 50-year-old male developed SO, with unusual peribulbar conjunctival pigmentation in the inciting eye. Histological examination of the conjunctival biopsy revealed perivascular distribution of CD68⁺ melanophages that also expressed HLA-DR, suggesting that these macrophages may act as antigen-presenting cells. In addition, increased CD4⁺ and CD3⁺ lymphocytes were noted in the subconjunctival space when compared to specimens of normal conjunctiva and traumatic uveal prolapse without SO, suggesting T-cell recruitment.

Conclusions: These pathologic findings suggest a possible mechanism by which local antigen processing by subconjunctival melanophages may play a role in the initiation of the complex cell-mediated response seen in SO.     

Endophthalmitis Caused by Citrobacter Species

Purpose: To investigate clinical settings, treatments, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Citrobacter species. Methods: Data were collected for organisms, surgical intervention, antibiotic sensitivity patterns, and final visual acuity. Results: Six eyes of 6 patients with culture-proven C. freundii (n = 4) or C. koseri(n = 2) endophthalmitis were identified. Clinical settings included cataract surgery (1 eye), cataract surgery combined with trabeculectomy (1), trauma (2), penetrating keratoplasty (1), and presumably endogenous source (1). Primary or secondary evisceration was performed in 3 eyes. Initial pars plana vitrectomy with intravitreal antibiotics was performed in 3 eyes. Final visual acuity was no light perception in 5 eyes, and 1 patient with traumatic C. koseri endophthalmitis achieved a final vision of 20/30. Conclusion: Despite treatment with appropriate antibiotics, Citrobacter endophthalmitis can be associated with a poor visual outcome. Early detection and management may improve the final visual outcome and prevent the possibility of evisceration.