Long-term study finds high complication rate in sympathetic ophthalmia, but good visual outcome

A 30-year retrospective analysis of 85 patients with sympathetic ophthalmia (SO) from three tertiary care centers showed ocular complications in almost half of sympathizing eyes on presentation, with 26 percent seeing 20/200 or worse. However, while the rate of new complications was 40 percent per person-year, 59 percent of patients maintained a visual acuity (VA) of better than 20/50 in their sympathizing eye, and 75 percent maintained a VA of better than 20/200. 

Optic nerve abnormality, cataract, exudative retinal detachment and active intraocular inflammation were the most significant factors in poorer VA.

Other ocular complications included macular edema and glaucoma (in about a third of eyes), and epiretinal membrane (in about one sixth of eyes). Less than 10 percent of eyes were phthisical. Cataract surgery increased vision by two lines or more in 89 percent of 16 eyes that underwent surgery in the follow-up period. 

Prednisone did seem to be a useful therapeutic approach; however, it's clear that long-term, high-dose systemic corticosteroids are not a viable option. 

This study reminds us that while SO is a potentially blinding disease, with proper treatment many eyes retain functional visual acuity long-term. This study was not powered to fully evaluate the role of early or late enucleation, but the authors note that there is recent evidence showing early enucleation may also be helpful in preventing SO.