Author Block: Zainab Khan, Sabrina Bergeron, Miguel Burnier, Marie-Josee Aubin
Author Disclosure Block: Z. Khan: None. S. Bergeron: None. M. Burnier: None. M. Aubin: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); University of Ottawa, Gilead. Description of relationship(s); Invited speaker, Uveitis investigators meeting. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); PeriPharma, Gilead.

Abstract Body:

Purpose: Sympathetic ophthalmia (SO) is a rare and dreaded complication of trauma resulting in granulomatous panuveitis in both the injured (inciting) and contralateral (sympathizing) eyes. SO typically comes to the attention of physicians after unequivocal disease onset, at which point vision may be permanently affected. This case is the first in which spectral-domain optical coherence tomography (SD-OCT) lead to diagnosing early SO in an otherwise asymptomatic patient.
Study Design: Case report.
Methods: Chart review. Histopathological examination of the enucleated eye. Ophthalmological evaluation, including Snellen visual acuity (VA), complete ocular examination, macular SD-OCT and fluorescein angiography (FA), over a 6 month period.
Results: A 23 year-old male sustained penetrating ocular trauma to his left eye while trimming trees. Initial globe repair occurred within hours of the injury and resulted in chronically exposed uvea. He was referred to the Oculoplastics service at Maisonneuve-Rosemont Hospital (HMR) in Montreal, Canada, for a painful eye with no visual potential and uneventful enucleation of the traumatized eye was performed 3 weeks following initial injury. One month postoperatively, the patient was referred to an optometrist for fitting of protective polycarbonate lenses. Routine SD-OCT of the right eye revealed retinal pigment epithelium abnormalities. The patient had no visual complaints and his VA was 6/6. SD-OCT was repeated at HMR and revealed a small serous retinal detachment with irregularity of the retinal pigment epithelium. FA showed a small pinpoint leak and optic disc leakage in the late-phase. The patient was diagnosed with SO on the basis of his history and imaging findings, and started on a tapering course of oral prednisone. The SD-OCT and FA abnormalities resorbed and at 6 months follow-up, ophthalmologic exam and imaging remained normal while solely on long-term immunosuppression with Mycophenolate mofetil. Histolopathologic examination of the enucleated left eye demonstrated non-granulomatous chorioidal inflammation thought to be compatible with a diagnosis of SO.
Conclusions: SD-OCT and FA are key tools in the diagnosis of SO. Currently, no guidelines exist for screening patients who sustained globe-penetrating injuries, This case report demonstrates that abnormalities on OCT can precede symptoms and clinical ocular findings typical of SO, and suggests that SD-OCT screening for SO should be recommended every 2-4 months within the first year of trauma and annually thereafter.