Patients Should Be Monitored for Sympathetic Ophthalmia Following Surgery or Trauma

While rare, sympathetic ophthalmia (SO) following ocular surgery or trauma may occur sooner than expected.

Study Design

The IRIS Registry was queried for ICD-9 and -10 codes 360.11 and H44.13 (including any alphanumeric digits following the H44.13), respectively, reflecting cases of sympathetic ophthalmia (SO) documented in the Registry between January 2013 and December 2019. The 1523 patients included were divided into 2 predefined cohorts: those who had a specified preceding ocular procedure (“Procedure Only” cohort) and those with ocular trauma (“Trauma” cohort).

Outcomes

Eighty-eight percent of patients were in the Procedure Only cohort. Within that cohort, the highest SO prevalence rates were seen in those who underwent “other anterior segment” or glaucoma surgery procedures (0.122% and 0.066%, respectively) and the lowest prevalence rate was in those who underwent cataract surgery (0.011%). The average time to onset of SO across the entire study population was 527.4 (±715.6) days; the average time to onset for the Trauma cohort was 385.5 (±538.0) days and the average time to onset for the Procedure Only cohort was 547.5 (±735.0) days, a statistically significant difference. There was a significantly higher proportion of female patients within the SO cohort (60.9%) compared with the general IRIS Registry patient population (56.8%), a significantly higher proportion of White patients (68.6% vs 57.1%), and a significantly higher proportion of Hispanic patients (9.7% vs 7.3%).

Limitations

The IRIS Registry is not a representative sample of eye care in the United States, and therefore this study may be an underrepresentation of SO cases. This is highlighted by the fact that there was a significantly lower percentage of unknown race and unknown ethnicity patients in the SO group than in the IRIS Registry as a whole, making it difficult to make any substantiated conclusions about racial or ethnic predisposition. The authors do not comment on the number of “safety net” hospitals in the IRIS Registry specifically or in the United States, further limiting the ability of the reader to ascertain the level of underrepresentation. Additionally, the type of trauma (i.e., penetration vs perforation vs other) was not defined.

Clinical Significance

Previously published studies have noted SO onset occurring anywhere from as soon as 5 days to as long as 66 years after an inciting event. Guided by the current study's findings, which narrow the potential timeframe for SO development, clinicians should provide focused monitoring during the first 4 years following an ocular procedure or a traumatic ocular event. Ophthalmologists can use these data when requesting informed consent for the ocular surgeries discussed in the paper. Clinicians should also be vigilant and regularly check both eyes for uveitis in both cohorts as this was present in one-third of the included patients.

Financial Disclosures: Dr. Nikisha Richards discloses financial relationships with Horizon Therapeutics (Consultant/Advisor).