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Posterior form sympathetic ophthalmia.

Two cases of posterior form sympathetic ophthalmia are presented. The histologic abnormalities in one of them are described. Based on findings in these two cases and other descriptions of posterior form sympathetic ophthalmia in the literature, the authors conclude that except for absence of anterior uveal tract involvement, there is no histopathologic difference between posterior form sympathetic ophthalmia and classical sympathetic ophthalmia. Although there is disagreement in the literature, the authors also conclude that the therapy and prognosis of posterior form sympathetic ophthalmia does not differ from that of classical sympathetic ophthalmia.

Adult

Immunopathology of sympathetic ophthalmia.

The long held notion that sympathetic ophthalmia represents an autoimmune reaction to uveal pigment is no longer tenable. Pigmentation influences the histopathologic picture of sympathetic ophthalmia but no evidence supports the role of uveal pigment as inciting antigen. Several recent studies have confirmed our initial report of the participation of cellular hypersensitivity to ocular tissues in the pathogenesis of this disease. Both clinical and experimental studies implicate retinal tissue as being more immunogenic than uveal antigens. The recent histopathologic observation that eosinophils concentrate near the choriocapillaris suggests that outer retina and retinal pigment epithelium should not be overlooked as a potential source of the stimulating antigen in sympathetic ophthalmia.

Animals

[Recent details of the frequency and immunologic reactivity of sympathetic ophthalmia (author's transl)].

When giving details of the frequency of Sympathetic Ophthalmia a clear distinction must be made between this disorder and the Phacogenic Ophthalmia also affecting the second eye. The latter is found with lens damage, whereas genuine Sympathetic Ophthalmia in relation to enucleation, eye damage and eye opening surgery at Heidelberg University between 1937 and 1973 is less than 1%, a figure markedly below figures quoted in the earlier literature. In two out of three patients with recent genuine Sympathetic Ophthalmia we found an augmented stimulation index in the LTT with retina antigen, not choroid antigen, as compared to control groups. This can be regarded as due to an individually augmented immunologic reactivity towards eye specific tissue antigens.

Antigen-Antibody Reactions

Recent advances in sympathetic ophthalmia.

Recent advances in understanding the pathogenesis of sympathetic ophthalmia are helping to remove the pigmented cloud which has obstructed the view of researchers on this disease for many years. Clinical features, diagnostic testing, histopathologic variations and principles of treatment are evaluated in the context of our increasing understanding of the pathogenesis of this disease. The relationship of sympathetic ophthalmia to Harada's disease and phacoantigenic uveitis are reviewed.

Autoantigens

Sympathetic ophthalmia: visual results with modern immunosuppressive therapy.

Sympathetic ophthalmia is a rare bilateral panuveitis that follows penetrating injury to one eye. The use of systemic corticosteroids has transformed the prognosis, and good acuity in the sympathizing eye can now be achieved. The use of immunosuppressive drugs, such as cyclosporin and azathioprine, in combination with the steroids, allows control of the intraocular inflammation at a much lower steroid dose, with concomitant reduction in the systemic side effects that accompany the use of systemic steroids.

Adolescent

[Fluorescein angiographic picture of sympathetic ophthalmia (author's transl)].

The fluorescein angiographic picture of sympathetic ophthalmia is described in an instructive case, which first started at the posterior pole. In the acute phase there was a picture of an exudative process with multiple subretinal enlarging hyperfluorecent spots and some dye-pooling. The retinal vasculature was unaffected. In the healing phase a transitory involvement of the optic nerve head was observed. The cicatricial phase was characterized by a coarsening of the pigment pattern of the fundus. In addition to fluorescein angiography the degree of transitory hyperopia was an excellent indicator of the activity of the disease process.

Fundus Oculi

Sympathetic ophthalmia. A long-term follow-up.

Seventeen cases of sympathetic ophthalmia have been followed up for as long as 23 years (average 10.6 years). Sixty-five percent of those patients treated with corticosteroids retained a visual acuity of 20/60 or better. Complications were frequent and included secondary glaucoma, cataract, exudative retinal detachment, and choroidal scarring. Uneventful cataract extraction was difficult to manage, requiring frequent changes in the steroid dosage, and in one patient two glaucoma procedures. The duration of steroid therapy was quite variable and ranged from a few months to six years or longer. Relapses were common and several occurred many years after the initial episode had resolved. If the histopathologic picture were moderate or severe, the clinical course most often would be difficult and protracted.

Adolescent

[Further investigations for the demonstration of a specific microorganism in sympathetik ophthalmia].

19 Following the inoculation of tissue culture cells with material obtained from 3 human eyes suffering from sympathetic ophthalmia (2 sympathizing = sy-l, 1 sympathized = sy-2), no growth of bacteria was observed. On the other hand, changes occurred such as are typical for a massive infection with mycoplasmas. The morphology of these microbes corresponds, down to the details, with micro-organisms which the author has frequently demonstrated and illustrated since 1948 in human, chicken and monkey eyes suffering from sympathetic ophthalmia. 2. With the cultures of mycoplasmas obtained from the eyes of human patients suffering from sympathetic ophthalmia, it was possible to produce the same symptoms in chickens as were described by the author in 1950 in sympathizing and sympathized human eyes, namely: torpid uveitis and papillitis, which dragged on for months, and affected not only the inoculated right eye, but also, after 3 weeks and more, the untouched left eye. 3. Identical phenomena involving both eyes have been observed in chickens, the right eyes of which were inoculated with a strain of mycoplasma hominis orale 1 cultivated from other material in the Institut für medizinische Mikrobiologie der Universität Mainz (Prof. Bredt) and given to the author. A chronic intraocular inflammation, which persisted for several months--up to 6 months and more--developed not only in the inoculated right eye of the animals, but also, after an interval of several weeks, in the untouched left eye. 4. Viewed critically and with due care, these findings suggest that mycoplasmas might well play a role in triggering off sympathetic ophthalmia. 5. The results reported on here indicate that intraocular inoculation with mycoplasmas is of importance both in microbiology and in general medicine.

Animals

Sympathetic uveitis after trauma and vitrectomy.

A case is describes in which the earliest clinical manifestations of sympathetic uveitis that occurred after trauma and pars plana vitrectomy were confined primarily to the retina, retinal pigment epithelium, and choroid posteriorly, and resembled focal lesions of acute posterior multifocal placoid pigment epitheliopathy. Similar focal lesions were noted on gross examination of the enucleated inciting eye. Histopathological examination revealed that these lesions were caused by focal choroidal granulomas and overlying Dalen-Fuchs nodules. Sympathetic ophthalmia was also noted in four other patients in whom the condition developed after trauma and vitrectomy.

Adult

Clinical and histopathologic observations in severe Vogt-Koyanagi-Harada syndrome.

Vogt-Koyanagi (V-K) syndrome is a severe anterior uveitis associated with alopecia, vitiligo, poliosis, and dysacousia. Harada's disease (HD) is primarily a posterior uveitis accompanied by signs of meningeal irritation and abnormalities of the cerebrospinal fluid. The overlapping of clinical manifestations between the two justified considering them as part of a spectrum of one disease (V-K-H). In a clinicopathologic study of nine cases four patients (three with V-K syndrome and one with V-K-H syndrome) histopathologically displayed a granulomatous uveitis. Five patients (two with V-K syndrome and three with HD) showed a nongranulomatous uveitis. We emphasized this latter finding, since in the past the diagnosis of this syndrome has been discarded both clinically and histopathologically because of the absence of a granulomatous uveitis. We established the clinical and histopathologic differences between V-K-H and sympathetic ophthalmia. The designation "uveomeningoencephalitic syndrome" stresses the key features of V-K-H, namely the uveal involvement and signs of meningeal irritation (that is, headaches, personality changes, and cerebrospinal fluid alterations).

Adult