WordNet

of or relating to the sympathetic nervous system; "sympathetic neurons"; "sympathetic stimulation"
(of characters in literature or drama) evoking empathic or sympathetic feelings; "the sympathetic characters in the play" (同)appealing, likeable, likable
expressing or feeling or resulting from sympathy or compassion or friendly fellow feelings; disposed toward; "sympathetic to the students cause"; "a sympathetic observer"; "a sympathetic gesture"
having similar disposition and tastes; "with their many similar tastes, he found her a most sympathetic companion"
severe conjunctivitis (同)ophthalmitis

PrepTutorEJDIC

『同情的な』,思いやりのある / 気に入った,好意的な,共鳴する / 《まれ》気性に合った,気心の合った
眼炎(目が赤くはれる炎症)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/20 18:45:04」(JST)

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Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous uveitis (a kind of inflammation) of both eyes following trauma to one eye. It can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury.

History

Although descriptions of sympathetic ophthalmia can be found in ancient Greek texts, modern understanding of SO derives from the works of William MacKenzie, who characterized and named the disease sympathetic ophthalmitis. At MacKenzie's time, oral mercury and leeches applied to the conjunctiva were the treatments of choice for SO.^[1]

It is thought that Louis Braille, who injured his left eye as a child, lost vision in his right eye owing to SO.^[2] James Thurber's adult blindness was also diagnosed as sympathetic ophthalmia deriving from the loss of an eye when he was six years old.^[3]

Epidemiology

Sympathetic ophthalmia is rare, affecting 0.2% to 0.5% of non-surgical eye wounds, and less than 0.01% of surgical penetrating eye wounds. There are no gender or racial differences in incidence of SO.

Pathophysiology

Sympathetic ophthalmia is currently thought to be an autoimmune inflammatory response toward ocular antigens, specifically a delayed hypersensitivity to melanin-containing structures from the outer segments of the photoreceptor layer of the retina. The immune system, which normally is not exposed to ocular antigens, is introduced to the contents of the eye following traumatic injury. Once exposed, it senses these antigens as foreign, and begins attacking them. The onset of this process can be from days to years after the inciting traumatic event

Clinical features

Floating spots and loss of accommodation are among the earliest symptoms. The disease may progress to severe uveitis with pain and photophobia. Commonly the eye remains relatively painless while the inflammatory disease spreads through the uvea, where characteristic focal infiltrates in the choroid named Dalén-Fuchs nodules can be seen. The retina, however, usually remains uninvolved, although perivascular cuffing of the retinal vessels with inflammatory cells may occur. Papilledema, secondary glaucoma, vitiligo, and poliosis of the eyelashes may accompany SO.

Diagnosis

Diagnosis is clinical, seeking a history of eye injury. An important differential diagnosis is Vogt-Koyanagi-Harada syndrome (VKH), which is thought to have the same pathogenesis, without a history of surgery or penetrating eye injury.

Still experimental, skin tests with soluble extracts of human or bovine uveal tissue are said to elicit delayed hypersensitivity responses in these patients. Additionally, circulating antibodies to uveal antigens have been found in patients with SO and VKH, as well as those with long-standing uveitis, making this a less than specific assay for SO and VKH.

Prevention and treatment

If the injured eye has lost its vision and has no hope for useful vision in future, prevention of SO is done by enucleation of the injured eye preferably within the first 2 weeks of injury. Evisceration—the removal of the contents of the globe while leaving the sclera and extraocular muscles intact—is easier to perform, offers long-term orbital stability, and is more aesthetically pleasing, i.e., a greater measure of movement of the prosthesis and thus a more natural appearance. There is concern, however, that evisceration may lead to a higher incidence of SO compared to enucleation.^[4] Several retrospective studies involving over 3000 eviscerations, however, have failed to identify a single case of SO.

Because SO is so rarely encountered following eye injury, even when the injured eye is retained, the first choice of treatment may not be enucleation or evisceration, especially if there is a chance that the injured eye may regain some function.^[5] Additionally, with current advanced surgical techniques, many eyes once considered nonviable now have a fair prognosis.

Once SO is developed, Immunosuppressive therapy is the mainstay of treatment. When initiated promptly following injury, it is effective in controlling the inflammation and improving the prognosis. Mild cases may be treated with local application of corticosteroids and pupillary dilators. More severe or progressive cases require high-dose systemic corticosteroids for months to years. Patients who become resistant to corticosteroids or develop side effects of long-term corticosteroid therapy (osteoporosis and pathologic fractures, mental status changes, etc.), may be candidates for therapy with chlorambucil, cyclophosphamide, or ciclosporin.

References

^ ^a ^b Albert, DM; Diaz-Rohena, R (Jul–Aug 1989). "A historical review of sympathetic ophthalmia and its epidemiology.". Survey of ophthalmology 34 (1): 1–14. PMID 2678549. Cite uses deprecated parameters (help)
^ ^a ^b Kaden, R (Jan 1977). "[Historic notices of Louis braille and the development of dot-writing (author's transl)].". Klinische Monatsblatter fur Augenheilkunde 170 (1): 154–8. PMID 321864.
^ http://archopht.ama-assn.org/cgi/reprint/120/5/628.pdf
^ ^a ^b Migliori, ME (Oct 2002). "Enucleation versus evisceration.". Current opinion in ophthalmology 13 (5): 298–302. PMID 12218460.
^ ^a ^b Gürdal, C; Erdener, U; Irkeç, M; Orhan, M (Sep 2002). "Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment.". Ocular immunology and inflammation 10 (3): 223–7. PMID 12789598. Cite uses deprecated parameters (help)
^ Chu, DS; Foster, CS (Summer 2002). "Sympathetic ophthalmia.". International ophthalmology clinics 42 (3): 179–85. PMID 12131594. Cite uses deprecated parameters (help)
^ Damico, FM; Kiss, S; Young, LH (Jul–Sep 2005). "Sympathetic ophthalmia.". Seminars in ophthalmology 20 (3): 191–7. doi:10.1080/08820530500232100. PMID 16282154. Cite uses deprecated parameters (help)
^ Friedlaender, MH and O'Connor GR (2001). Medical immunology (10th ed. ed.). Lange Medical Books/McGraw-Hill. ISBN 0-8385-6300-7.
^ Zaharia, MA; Lamarche, J; Laurin, M (Aug 1984). "Sympathetic uveitis 66 years after injury.". Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 19 (5): 240–3. PMID 6478310. Cite uses deprecated parameters (help)

UpToDate Contents

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English Journal

SPONTANEOUS DISLOCATION OF A FLUOCINOLONE ACETONIDE IMPLANT (RETISERT) INTO THE ANTERIOR CHAMBER AND ITS SUCCESSFUL EXTRACTION IN SYMPATHETIC OPHTHALMIA.

Almeida DR1, Chin EK, Mears K, Russell SR, Mahajan VB.
Retinal cases & brief reports.Retin Cases Brief Rep.2014 Nov 19. [Epub ahead of print]
PURPOSE:: To report a case of spontaneous fluocinolone acetonide (Retisert) implant dislocation and migration into the anterior chamber.METHODS:: Retrospective case report.PATIENTS:: One patient with sympathetic ophthalmia uveitis was well controlled by fluocinolone acetonide implants.RESULTS:: The
PMID 25411930

Spectral-domain optical coherence tomography of sympathetic ophthalmia with dalen-fuchs nodules.

Muakkassa NW, Witkin AJ.
Ophthalmic surgery, lasers & imaging retina.Ophthalmic Surg Lasers Imaging Retina.2014 Nov 1;45(6):610-2. doi: 10.3928/23258160-20141008-01. Epub 2014 Oct 29.
The authors present a case of sympathetic ophthalmia with Dalen-Fuchs nodules visualized with spectral-domain optical coherence tomography (SD-OCT). An 84-year-old man presented with floaters and decreased vision 25 years after penetrating trauma to the fellow eye. Examination revealed vitritis and
PMID 25347826

Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis.

Mehta S1, Linton MM2, Kempen JH3.
American journal of ophthalmology.Am J Ophthalmol.2014 Oct;158(4):676-692.e7. doi: 10.1016/j.ajo.2014.06.018. Epub 2014 Jun 28.
PURPOSE: To critically assess the evidence base regarding outcomes following cataract surgery in uveitic cases.DESIGN: Systematic evidence-based review and meta-analysis.METHODS: A comprehensive search query was performed on MEDLINE, EMBASE, CINHAL, and CENTRAL databases. Relevant publications were
PMID 24983790