Transcript Diapositiva 1 - Dott. Paolo Tortorella Oculista

SYMPATHETIC OPHTHALMIA:
EXPERIENCE IN A TERTIARY REFERRAL CENTER
P. Tortorella, R. Spena, A. Sapia, R. Zito, M. La Cava, M.P. Paroli
“Sapienza” University of Rome
Department of Ophthalmology
Ocular Immunovirology Service
Hamburg 26-29 September 2013
13th Euretina Congress
PURPOSE
We carried out a retrospective study on patients (pt) with Sympathetic Ophthalmia
who were referred to our tertiary referral center of Ocular Immunovirology
from January 2001 to 30 March 2012.
We also compared the new data with those of a study done in the same center
between 1986 and 2000.
Sympathetic Ophthalmia (SO)
is a diffuse, bilateral, granulomatous, recurring uveitis.
SO occurs after a penetrating or, more rarely, contusive ocular trauma,
or usually after multiple surgeries and parasurgeries,
both on the injured eye (sympathizer) and on the contralateral one (sympathetic).
METHODS
Only 12 (0.3%) out of 3635 new pt with uveitis were suffering from SO.
The 12 pt (M:F 10:2) had a follow up(FU) of 46.27 ± 39.25 (1-129) months.
The following factors were considered:
- triggering event
- time interval between the trauma occurred and the onset of SO
- evolution of the disease
- type of treatment
- differences in the evolution of post-surgical and post-traumatic forms
RESULTS
Noxa
1986-2001
2002-2012
Trauma
52.63% (10 pt)
33.33% (4 pt)
Trauma + Surgery
31.57% (6 pt)
33.33% (4 pt)
Multiple surgeries
15.78% (3 pt)
33.33% (4 pt)
Total post-surgical forms
47.36% (9 pt)
66.66% (8 pt)
From January 2001 to 30 March 2012…
The average age:
- when triggering event occurred: 32.37 ± 17.73 yr (8-60).
- at the onset SO: 46.27 ± 15.30 yr (17-68).
Latency period between triggering event and onset of SO: <1 month: 41.66% (5pt)
<10 years 75% (9pt)
>21 years: 25% (3pt)
Evolution of the disease:
At a first analysis…
- In the sympathizer eye 8 pt (66.66%) had a turned off condition (already undergone enucleation
surgery), 4 pt (33.33%) had a visual acuity (VA) of at least 0.70 logMAR.
- All patients had an average VA 0.10 logMAR in the sympathetic eye that remained stable over time.
- Complications during FU: glaucoma (66.66%), cataract (25%), cystoid macular edema (16.66%).
RESULTS
Treatment
- In 1 pt (8.3%) enucleation was performed in a turned-off eye before SO developed in the
sympathetic eye, rather than as a prevention.
In this case SO occurred within a month from enucleation.
- All pt have responded to topical and systemic steroid therapy.
- In 6 pt (50%) a therapy based on immunosuppressants was necessary, due to drug resistance and
resulting complications.
- None has ever taken biological drugs.
The number of new cases of SO seems to have gradually reduced, from 0.6% (1986-2000)
to 0.3% (2001-2012) of new examinations.
We finally found a marked increase in cases with post-surgical etiology compared to
exclusively post-traumatic forms.
There aren’t differences in the evolution of post-surgical and post-traumatic forms.
CONCLUSIONS
• Early diagnosis and adequate medical treatment guarantee a good visual
prognosis.
• Before the use of corticosteroids the prognosis was poor: more than 70%
of eyes became permanent blind. However corticosteroids and
immunosuppressant have not a preventive role.
• Enucleation is the only treatment that can theoretically prevent the onset
of SO, but any residual vision should be preserved.
• Relative increase of post-surgical forms.
• It's important to bear in mind the risk of SO in ophthalmic surgery,
especially in those patients who undergo multiple interventions, also
taking into account the possibility to refrain from executing other surgical
interventions on hopelessly compromised eyes.
FINANCIAL DISCLOSURE:
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.