Multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia_Chinese Journal of Ocular Fundus Diseases

Authors：

Cheng Yizhe ¹ , Zhang Chengrui ^1,2 , Chen Chunli ¹ , Zhang Zhihan ¹ , Hou Simeng ¹ ,  Peng Xiaoyan ¹

1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing ophthalmology & Visual Sciences Key Lab, Beijing 100730, China;
2. Department of Ophthalmology, Beijing Nuclear Industry Hospital, Beijing 100045, China;

Corresponding author：

Peng Xiaoyan, Email: 74000041@ccmu.edu.cn

Keywords：

Ophthalmia, sympathetic; Fluorescein angiography; Tomography, optical coherence; Multimodal imaging

DOI：

10.3760/cma.j.cn511434-20220127-00051

Video：

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Objective To observe and analyze the multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia (SO). Methods A retrospective study. From October 2012 to December 2021, 28 patients (36 eyes) diagnosed SO in the Department of Ophthalmology, Beijing Tongren Hospital were inclued in the study. There were 19 males (25 eyes) and 9 females (11 eyes), with the mean age of 51.61±12.02 years. There were 8 exciting eyes and 28 sympathizing eyes. The time to onset after trauma or surgery was 46.10±107.98 months. All patients underwent examinations including vision test, color fundus photograph, optical coherence tomography (OCT), fundus fluorescence angiography (FFA), indocyanine green angiography (ICGA). Angio-OCT (OCTA) was performed on 3 eyes and fundus autofluorescence (AF) was performed on 8 eyes. The early and late phase were defined respectively as ≤2 months and ＞2 months. Their multimodal imaging characteristics were summarized. Results In 8 exciting eyes, subretinal fibrosis with mutifocal retinal atrophy and pigmentation was noted in 5 eyes (62.50%, 5/8), the other 3 eyes showed sunset glow fundus (37.50%, 3/8). In 28 sympathizing eyes, in the early phase, the fundus photograph showed shallow retinal detachment with optic disc edema in 9 eyes (32.14%, 9/28); in the late phase, peripapillary yellowish-white subretinal lesions in 11 eyes (39.29%, 11/28). In the late course of the disease, there were yellow-white lesions around the optic disc (peridisc) and peripheral subretinal area in 11 eyes (39.29%, 11/28). Dalen-Fuchs nodules were found in 10 eyes (35.71%, 10/28). On OCT, multiple serous retinal detachment and irregular choroidal folds were noted in the early phase; hill-like subretinal hyperreflective elevation was noted in peripapillary area and subfovea with presence of cystic spaces in the intraretina in the late phase. FFA examination showed "pinpoint-like" strong fluorescence in the early stage, and "multi-lake-like" fluorescein accumulation and leakage in the late stage; "map-like" weak fluorescence around the disc in the early stage of the disease, dot-like strong fluorescence lesions in each quadrant of the peripheral retina, and fluorescence in the late stage of the disease course. enhanced. ICGA examination showed that the FFA strong fluorescence lesions in the middle and late stages were weak fluorescence. FAF examination, point-like strong and weak autofluorescence lesions with unclear boundaries. Nine sympathizing eyes with subretinal yellow-white lesions has vision without light-0.1 (significantly decreased vison), while 8 eyes with sunset glow fundus was 0.5-1.0 (mildly decreased vison). Conclusions SO could not only show the semblable features of acute phases of Vogt-Koyanagi-Harada syndrome, but also the yellowish-white lesions in the peripapillary area, macula and periphery. Most of the eyes with peripapillary lesions has a significantly decreased vison, while the eyes with sunset glow fundus has a mildly decreased vison.

Citation： Cheng Yizhe, Zhang Chengrui, Chen Chunli, Zhang Zhihan, Hou Simeng, Peng Xiaoyan. Multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia. Chinese Journal of Ocular Fundus Diseases, 2022, 38(5): 359-365. doi: 10.3760/cma.j.cn511434-20220127-00051 Copy

1.	Chang GC, Young LH. Sympathetic ophthalmia[J]. Semin Ophthalmol, 2011, 26(4-5): 316-320. DOI: 10.3109/08820538.2011.588658.
2.	Hansen BA, Soukiasian SH. Approach to the laboratory, imaging, and molecular work-up for uveitis[M]//Papaliodis GN. Uveitis: a practical guide to the diagnosis and treatment of intraocular inflammation. Cham: Springer International Publishing, 2017: 9-34.
3.	Gupta V, Gupta A, Dogra MR. Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India[J]. Eye (Lond), 2008, 22(12): 1459-1464. DOI: 10.1038/sj.eye.6702927.
4.	Babu K, Jidesh MV, Sudheer B, et al. Progressive, subretinal fibrosis mimicking retinal necrosis with poor visual prognosis in sympathetic ophthalmia: a rare finding[J]. Indian J Ophthalmol, 2018, 66(12): 1877-1879. DOI: 10.4103/ijo.IJO_268_18.
5.	Steeples LR, Ashworth J, Jones N. Multifocal chorioretinitis with progressive subretinal fibrosis in a young child[J/OL]. BMJ Case Rep, 2015, 2015: bcr2015212526[2015-10-14]. https://pubmed.ncbi.nlm.nih.gov/26468224/. DOI: 10.1136/bcr-2015-212526.
6.	Wang RC, Zamir E, Dugel PU, et al. Progressive subretinal fibrosis and blindness associated with multifocal granulomatous chorioretinitis: a variant of sympathetic ophthalmia[J]. Ophthalmology, 2002, 109(8): 1527-1531. DOI: 10.1016/s0161-6420(02)01108-9.
7.	Rogaczewska M, Iwanik K, Stopa M. Early presentation of sympathetic ophthalmia in optical coherence tomography studies: a case report[J]. Indian J Ophthalmol, 2020, 68(9): 2019-2022. DOI: 10.4103/ijo.IJO_2184_19.
8.	Mahajan S, Invernizzi A, Agrawal R, et al. Multimodal imaging in sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2017, 25(2): 152-159. DOI: 10.1080/09273948.2016.1255339.
9.	Williams AM, Shepler AM, Chu CT, et al. Sympathetic ophthalmia presenting 5 days after penetrating injury[J/OL]. Am J Ophthalmol Case Rep, 2020, 19: 100816[2020-07-09]. https://pubmed.ncbi.nlm.nih.gov/32695926/. DOI: 10.1016/j.ajoc.2020.100816.
10.	Chean CS, Lim CS, Kumar P, et al. An atypical presentation of sympathetic ophthalmia in an intact globe following mechanical fall: a case report and literature review[J]. Vision (Basel), 2021, 5(1): 11. DOI: 10.3390/vision5010011.
11.	Hosseini SM, Shoeibi N, Azimi Zadeh M, et al. Persumed sympathetic ophthalmia after scleral buckling surgery: case report[J]. J Ophthalmic Inflamm Infect, 2021, 11(1): 4. DOI: 10.1186/s12348-020-00233-z.
12.	李冰, 叶俊杰, 张枝桥, 等. 交感性眼炎一例[J]. 中华眼科杂志, 2018, 54(6): 469-470. DOI: 10.3760/cma.j.issn.0412-4081.2018.06.015.Li B, Ye JJ, Zhang ZQ, et al. A case of sympathetic ophthalmia[J]. Chin J Ophthalmol, 2018, 54(6): 469-470. DOI: 10.3760/cma.j.issn.0412-4081.2018.06.015.
13.	李雁, 张晓敏. 交感性眼炎的临床特点及临床治疗效果[J]. 中国继续医学教育, 2017, 9(3): 125-127. DOI: 10.3969/j.issn.1674-9308.2017.03.070.Li Y, Zhang XM. Clinical features and curative effect of sympathetic ophthalmia[J]. China Continuing Medical Education, 2017, 9(3): 125-127. DOI: 10.3969/j.issn.1674-9308.2017.03.070.
14.	李柏军, 刘身文, 刘静雯, 等. 眼外伤后交感性眼炎相关因素分析[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 801-804. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.001.Li BJ, Liu SW, Liu JW, et al. Analysis on correlative factors of sympathetic ophthalmia after ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 801-804. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.001.
15.	宋殊琪, 郝晓璐, 侯豹可, 等. 玻璃体切除术后交感性眼炎的临床分析[J]. 中华眼外伤职业眼病杂志, 2014, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-1477.2014.06.001.Song SQ, Hao XL, Hou BK, et al. Clinical analysis of sympathetic ophthalmia after vitrectomy[J]. Chin J Ocul Traum Occupat Eye Dis, 2014, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-1477.2014.06.001.
16.	The Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for sympathetic ophthalmia[J]. Am J Ophthalmol, 2021, 228: 212-219. DOI: 10.1016/j.ajo.2021.03.048.
17.	Yang P, Liu S, Zhong Z, et al. Comparison of clinical features and visual outcome between sympathetic ophthalmia and Vogt-Koyanagi-Harada disease in Chinese patients[J]. Ophthalmology, 2019, 126(9): 1297-1305. DOI: 10.1016/j.ophtha.2019.03.049.
18.	Belmonte Grau M, Acebes García M, Jacobo González Guijarro J. Multifocal choroiditis and choroidal tuberculoma: signs of presumed ocular tuberculosis[J/OL]. Eur J Ophthalmol, 2021, 2021: 11206721211039938[2021-08-21]. https://pubmed.ncbi.nlm.nih.gov/34420419/. DOI: 10.1177/11206721211039938.
19.	Lim WK, Chee SP, Sng I, et al. Immunopathology of progressive subretinal fibrosis: a variant of sympathetic ophthalmia[J]. Am J Ophthalmol, 2004, 138(3): 475-477. DOI: 10.1016/j.ajo.2004.04.013.
20.	Zhuang H, Zhang R, Zhang T, et al. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia[J]. Orphanet J Rare Dis, 2022, 17(1): 103. DOI: 10.1186/s13023-022-02258-0.
21.	Cunningham ET, Kilmartin D, Agarwal M, et al. Sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2017, 25(2): 149-151. DOI: 10.1080/09273948.2017.1305727.
22.	Reynard M, Riffenburgh RS, Minckler DS. Morphological variation of Dalén-Fuchs nodules in sympathetic ophthalmia[J]. Br J Ophthalmol, 1985, 69(3): 197-201. DOI: 10.1136/bjo.69.3.197.
23.	Abdelmaksoud A, Terk-Howe Khoo N, Sears K, et al. Novel optical coherence tomography fingdings of a case of sympathetic ophthalmia after 23-Gauge vitrectomoy[J]. Retin Cases Brief Rep, 2021, 15(5): 543-547. DOI: 10.1097/icb.0000000000000847.
24.	Saatçi AO, Ayhan Z, İpek ŞC, et al. Intravitreal Aflibercept as an adjunct to systemic therapy in a case of choroidal neovascular membrane associated with sympathetic ophthalmia[J]. Turk J Ophthalmol, 2018, 48(4): 209-211. DOI: 10.4274/tjo.09076.

1. Chang GC, Young LH. Sympathetic ophthalmia[J]. Semin Ophthalmol, 2011, 26(4-5): 316-320. DOI: 10.3109/08820538.2011.588658.
2. Hansen BA, Soukiasian SH. Approach to the laboratory, imaging, and molecular work-up for uveitis[M]//Papaliodis GN. Uveitis: a practical guide to the diagnosis and treatment of intraocular inflammation. Cham: Springer International Publishing, 2017: 9-34.
3. Gupta V, Gupta A, Dogra MR. Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India[J]. Eye (Lond), 2008, 22(12): 1459-1464. DOI: 10.1038/sj.eye.6702927.
4. Babu K, Jidesh MV, Sudheer B, et al. Progressive, subretinal fibrosis mimicking retinal necrosis with poor visual prognosis in sympathetic ophthalmia: a rare finding[J]. Indian J Ophthalmol, 2018, 66(12): 1877-1879. DOI: 10.4103/ijo.IJO_268_18.
5. Steeples LR, Ashworth J, Jones N. Multifocal chorioretinitis with progressive subretinal fibrosis in a young child[J/OL]. BMJ Case Rep, 2015, 2015: bcr2015212526[2015-10-14]. https://pubmed.ncbi.nlm.nih.gov/26468224/. DOI: 10.1136/bcr-2015-212526.
6. Wang RC, Zamir E, Dugel PU, et al. Progressive subretinal fibrosis and blindness associated with multifocal granulomatous chorioretinitis: a variant of sympathetic ophthalmia[J]. Ophthalmology, 2002, 109(8): 1527-1531. DOI: 10.1016/s0161-6420(02)01108-9.
7. Rogaczewska M, Iwanik K, Stopa M. Early presentation of sympathetic ophthalmia in optical coherence tomography studies: a case report[J]. Indian J Ophthalmol, 2020, 68(9): 2019-2022. DOI: 10.4103/ijo.IJO_2184_19.
8. Mahajan S, Invernizzi A, Agrawal R, et al. Multimodal imaging in sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2017, 25(2): 152-159. DOI: 10.1080/09273948.2016.1255339.
9. Williams AM, Shepler AM, Chu CT, et al. Sympathetic ophthalmia presenting 5 days after penetrating injury[J/OL]. Am J Ophthalmol Case Rep, 2020, 19: 100816[2020-07-09]. https://pubmed.ncbi.nlm.nih.gov/32695926/. DOI: 10.1016/j.ajoc.2020.100816.
10. Chean CS, Lim CS, Kumar P, et al. An atypical presentation of sympathetic ophthalmia in an intact globe following mechanical fall: a case report and literature review[J]. Vision (Basel), 2021, 5(1): 11. DOI: 10.3390/vision5010011.
11. Hosseini SM, Shoeibi N, Azimi Zadeh M, et al. Persumed sympathetic ophthalmia after scleral buckling surgery: case report[J]. J Ophthalmic Inflamm Infect, 2021, 11(1): 4. DOI: 10.1186/s12348-020-00233-z.
12. 李冰, 叶俊杰, 张枝桥, 等. 交感性眼炎一例[J]. 中华眼科杂志, 2018, 54(6): 469-470. DOI: 10.3760/cma.j.issn.0412-4081.2018.06.015.Li B, Ye JJ, Zhang ZQ, et al. A case of sympathetic ophthalmia[J]. Chin J Ophthalmol, 2018, 54(6): 469-470. DOI: 10.3760/cma.j.issn.0412-4081.2018.06.015.
13. 李雁, 张晓敏. 交感性眼炎的临床特点及临床治疗效果[J]. 中国继续医学教育, 2017, 9(3): 125-127. DOI: 10.3969/j.issn.1674-9308.2017.03.070.Li Y, Zhang XM. Clinical features and curative effect of sympathetic ophthalmia[J]. China Continuing Medical Education, 2017, 9(3): 125-127. DOI: 10.3969/j.issn.1674-9308.2017.03.070.
14. 李柏军, 刘身文, 刘静雯, 等. 眼外伤后交感性眼炎相关因素分析[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 801-804. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.001.Li BJ, Liu SW, Liu JW, et al. Analysis on correlative factors of sympathetic ophthalmia after ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 801-804. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.001.
15. 宋殊琪, 郝晓璐, 侯豹可, 等. 玻璃体切除术后交感性眼炎的临床分析[J]. 中华眼外伤职业眼病杂志, 2014, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-1477.2014.06.001.Song SQ, Hao XL, Hou BK, et al. Clinical analysis of sympathetic ophthalmia after vitrectomy[J]. Chin J Ocul Traum Occupat Eye Dis, 2014, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-1477.2014.06.001.
16. The Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for sympathetic ophthalmia[J]. Am J Ophthalmol, 2021, 228: 212-219. DOI: 10.1016/j.ajo.2021.03.048.
17. Yang P, Liu S, Zhong Z, et al. Comparison of clinical features and visual outcome between sympathetic ophthalmia and Vogt-Koyanagi-Harada disease in Chinese patients[J]. Ophthalmology, 2019, 126(9): 1297-1305. DOI: 10.1016/j.ophtha.2019.03.049.
18. Belmonte Grau M, Acebes García M, Jacobo González Guijarro J. Multifocal choroiditis and choroidal tuberculoma: signs of presumed ocular tuberculosis[J/OL]. Eur J Ophthalmol, 2021, 2021: 11206721211039938[2021-08-21]. https://pubmed.ncbi.nlm.nih.gov/34420419/. DOI: 10.1177/11206721211039938.
19. Lim WK, Chee SP, Sng I, et al. Immunopathology of progressive subretinal fibrosis: a variant of sympathetic ophthalmia[J]. Am J Ophthalmol, 2004, 138(3): 475-477. DOI: 10.1016/j.ajo.2004.04.013.
20. Zhuang H, Zhang R, Zhang T, et al. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia[J]. Orphanet J Rare Dis, 2022, 17(1): 103. DOI: 10.1186/s13023-022-02258-0.
21. Cunningham ET, Kilmartin D, Agarwal M, et al. Sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2017, 25(2): 149-151. DOI: 10.1080/09273948.2017.1305727.
22. Reynard M, Riffenburgh RS, Minckler DS. Morphological variation of Dalén-Fuchs nodules in sympathetic ophthalmia[J]. Br J Ophthalmol, 1985, 69(3): 197-201. DOI: 10.1136/bjo.69.3.197.
23. Abdelmaksoud A, Terk-Howe Khoo N, Sears K, et al. Novel optical coherence tomography fingdings of a case of sympathetic ophthalmia after 23-Gauge vitrectomoy[J]. Retin Cases Brief Rep, 2021, 15(5): 543-547. DOI: 10.1097/icb.0000000000000847.
24. Saatçi AO, Ayhan Z, İpek ŞC, et al. Intravitreal Aflibercept as an adjunct to systemic therapy in a case of choroidal neovascular membrane associated with sympathetic ophthalmia[J]. Turk J Ophthalmol, 2018, 48(4): 209-211. DOI: 10.4274/tjo.09076.

Chinese Journal of Ocular Fundus Diseases

Multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia

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