Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
ObjectiveTo analyse the effect of vitrectomy in diagnosing and treating endogenous endophthalmitis. MethodsThe effects of treatment, prognosis and the final follow-up visual acuity of 22 patients (30 eyes) with endogenous endophthalmitis diagnosed in our hospital from Jan 2000 to Dec 2003 were retrospectively reviewed.ResultsIn 21 patients who underwent blood or vitreous body smear and culture, 18 (86%) had a positive result, including bacteria in 6, fungi in 11, and mixed infection in 1. In 16 patients who had complete follow-up data, successful vitrectomy were performed on 13 (81.3%) including 6 with functional success.ConclusionVitrectomy may improve the positive rate of culture and vision prognosis in patients with endogenous endophthalmitis.(Chin J Ocul Fundus Dis, 2005,21:142-144)
Objective To observe the therapeutic effects of vitrectomy combined with tissue plasminogen activator(r-tPA) and fraxiparine on bacterial endophthalmitis. Methods Forty pigmented rabbits were randomly divided into experimental and control group with 20 rabbits in each. The left eyes underwent intra-vitreous injection with 10 5/ml bacteria of staphylococcus epidermidis 0.1 ml. After 8-4 hours, vitrectomy was performed on all of the animals. Fraxiparine with the final concentration of 6 IU/ml was only added to balanced salt solution in the experimental group during the operation, and the extend of intraocular fibrin exudation was observed by slit lamp and indirect ophthalmoscope after the operation. If the exudation occurred on the 1st, 3rd, 7th, 14th and 21st day postoperatively, 125 mg/ml r-tPA 0.1 ml should be injected into vitreous from the 1st day after operation on. Results Fibrin exudation in the pupil area and vitreous body was much less in experimental group than that in the control group after the surgery. Conclusion vitrectomy combined with r-tPA and fraxiparine may alleviate the extent of fibrosis in bacterial endophthalmitis and improve the prognosis. (Chin J Ocul Fundus Dis, 2005, 21: 391-393)
Objective To observe the effect of celastrol on the secretion of interleukin (IL)-17 in peripheral blood mononuclear cells in patients with sympathetic ophthalmia (SO), and its possible mechanisms. Methods Venous blood samples were extracted from 10 cases of sympathetic ophthalmia patients and 10 health objectives. The peripheral blood mononuclear cells (PBMCs) were isolated by density gradient centrifugation and then were divided into 4 groups. Group A (control group): PBMCs of health objectives; Group B: PBMCs of SO patients; Group C: PBMCs of SO patients with 0.5 μmol/L celastrol in the medium; Group D: PBMCs of SO patients with 1 μmol/L celastrol in the medium. After culturing the cells for 3 days, the supernatant of 4 groups was collected, and the levels of IL-23 and IL-17 were detected by enzyme-linked immuno sorbent assay (ELISA). Then, the 50 ng/ml rIL-23 was added into the medium of group A which was the group A1; the 50ng/ml rIL-23 and 1 μmol/L Cela were added into to the medium of group A which was the group A2. For the medium of group B, the 50 ng/ml rIL-23 was added into the medium which was the group B1; the 50 ng/ml rIL-23 and 1 μmol/L celastrol were added into to the medium of group B which was the group B2. After culturing for 3 days, the supernatant of cells of these 4 groups was collected, and the levels of IL-17 were detected by ELISA. Results In group A, the levels of IL-23 and IL-17 were (228.43±17.27) pg/ml and (220.55±31.15) pg/ml respectively. In group B, the levels of IL-23 and IL-17 were (513.85±36.46) pg/ml and (866.77±72.92) pg/ml respectively. In group C, the levels of IL-23 and IL-17 were (381.07±20.93) pg/ml and (517.43±54.87) pg/ml respectively. In group D, the levels of IL-23 and IL-17 were (237.14±17.97) pg/ml and (242.89±34.09) pg/ml respectively. Between group A and D, there was no statistically significant difference in IL-23 or IL-17 level (P＞0.05); but when comparing other groups, the differences were statistically significant (P＜0.05). The levels of IL-17 in group A1 and group A2 were (428.43±24.53) pg/ml and (229.15±23.28) pg/ml and the difference was statistically significant (P＜0.05). The levels of IL-17 in group B1 and group B2 were (1373.39±89.51) pg/ml and (571.01±94.88) pg/ml and the difference was statistically significant (P＜0.05). Conclusion Celastrol can inhibit the secretion of IL-17 by PBMCs in SO patients via inhibiting the secretion of IL-23.
Sympathetic ophthalmia (SO) is a bilateral granulomatous uveitis that occurs after single eye surgery or internal eye surgery. Its pathogenesis is not yet clear, and it is mostly considered to be an immune disease caused by exposure to autoantigens. The clinical diagnosis mainly depends on the patient's medical history, typical clinical manifestations and signs, and auxiliary ophthalmic imaging examinations such as FFA, ICGA, OCT. The clinical manifestations of SO are complex and variable, and the disease is prone to relapse, which may eventually lead to blindness. At present, treatment is mainly through systemic glucocorticoid therapy combined with immunosuppressive agents and/or biological agents. Understanding the typical imaging manifestations of SO is helpful to confirm the diagnosis early in the clinic, and timely provide reasonable drug treatment to improve the prognosis of patients.
ObjectiveTo 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. ResultsIn 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). ConclusionsSO 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.