Cornea - I Free Papers - aioseducation

69th AIOC Proceedings, Ahmedabad 2011
2 cases with early presentation had excellent recovery while 3 patients had
moderate recovery due to retinal detachment, extensive RPE atrophy and
glaucomatous cupping.
Oral steroids were given in the dose of 1.5mg/kg body weight and the patients
were continued on a maintenance dose for 1 year. 2 patients were started on
Azathioprine 50mg/day while 1 patient was treated with Methotrexate.
DISCUSSION
Sympathic Ophthalmitis has been reported to occur mainly following trauma.
However it has also been reported to occur following ocular surgery like cataract
surgery, scleral buckling, parsplana vitrectomy 7 , laser photocoagulation Our
study included patients with sympathetic ophthalmitis developing after
penetrating keratoplasty. The indications for keratoplasty were leucomatous
corneal opacity following primary corneal repair (3 patients) and endothelial
decompensation following IOFB removal (2 patients). According to studies,
penetrating keratoplasty for corneal decompensation following IOFB removal
are at high risk for sympathetic ophthalmitis. 8
Dalen Fuchs Spots
The onset of symptoms usually occurs between 3 weeks to 6 months following
surgery. In our study, the symptoms in sympathizing eye occurred between
1-8 years after surgery. The typical presentation of sympathetic ophthalmitis
is a bilateral panuveitis that occurs after ocular
trauma or intraocular surgery. 9 In our study
the sympathizing eye showed mild- moderate
granulomatous anterior uveitis with vitritis
and multifocal choroiditis. Dalen Fuchs spots
with vitritis was present in 1 patient. This is
usually seen in 36%-47% cases. 10
In our study the exciting eye had 1-2 attacks
of endothelial rejection 6-8 months after
corneal grafting. It has been seen that corneal
Figure 1: Dalen Fuchs Spots endothelial rejection does precipitate the
sympathetic ophthalmitis as graft rejection
and sympathetic ophthalmitis have a similar cell- mediated cytotoxic reaction
towards antigens on uveal pigment epithelium. 11
Earlier sympathetic ophthalmitis was considered to be a dreaded disease,
however in our study as well as other recent studies, 1,7 it has been seen that if
treated early and adequately, it has a good visual outcome. Our study stresses
the need for surgeons to fully explain the risks involved to patients undergoing
penetrating keratoplasty in cases with trauma, post vitrectomy or probably
any ocular surgery compromising cornea and which may require penetrating
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