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Photo Essay
October 2004

Sympathetic Ophthalmia and Indocyanine Green Angiography

Arch Ophthalmol. 2004;122(10):1568. doi:10.1001/archopht.122.10.1568

A 21-year-old man noticed blurry vision in his right eye. Two weeksbefore the event, he had severe irritation of his left eye, which was blindsince early childhood. His visual acuity was 20/200 OD. Slitlamp examinationrevealed trace cells in the anterior chamber and mild vitreous inflammationin the right eye. A perforated anterior staphyloma was noted in the left eye(Figure 1). Ophthalmoscopic examinationof the right eye disclosed multifocal placoid serous retinal detachments inthe posterior pole (Figure 2). Fluoresceinangiography and indocyanine green angiography were performed (Figure 3). The clinical diagnosis was sympathetic ophthalmia. Thepatient was immediately treated with 250 mg of methylprednisolone intravenouslyevery 6 hours for 3 days and then switched to 80 mg of oral prednisone daily.One day after initiating pulse therapy, the left eye was enucleated. Pathologicexamination findings revealed a dense infiltrate of chronic inflammatory cellsincluding lymphocytes, plasma cells, and epitheloid and multinucleated giantcells with apparent pigment engulfment in the choroid (Figure 4), which confirmed the diagnosis. One week later, afterinitiating systemic corticosteroid therapy, the visual acuity improved to20/30 OD and repeated indocyanine green angiography revealed marked improvement(Figure 5).

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