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Choroidal neovascularization (CNV) is a sight-threatening complication of sympathetic ophthalmia, a classic example of endogenous posterior uveitis.1,2Cyclosporine (cyclosporin A) has been shown to be effective in the treatment of sight-threatening disease associated with active intraocular inflammation in adults.3 We present a case report illustrating resolution of CNV in a child with active refractory sympathetic ophthalmia after starting cyclosporine therapy.
A 3-year-old boy had a limbal rupture involving uveal prolapse of his right eye after he fell on his feeder cup. Primary repair was performed and postoperative visual acuity was 20/80 OD and 20/20 OS. When sympathetic ophthalmia developed 4 months later, his visual acuity deteriorated to finger counting in both eyes. Oral prednisone therapy at 1 mg/kg per day was started. His uveitis improved slowly; 1 year later he achieved a visual acuity of finger counting OD and 20/30 OS while receiving a maintenance dose of 1 mg/kg on alternate days. Funduscopy of the left eye revealed mild vitritis and a yellowish macular lesion, with a surrounding hyperpigmented ring and circinate hard exudates, which was clinically consistent with CNV (Figure 1). Despite systemic prednisone therapy, his visual acuity worsened to 20/200 OS 10 months later. Systemic cyclosporine therapy was added at 5 mg/kg per day. Three months later, visual acuity improved to 20/100 OD and 20/60 OS with resolution of left macular edema and hemorrhage (Figure 2).
Kilmartin DJ, Forrester JV, Dick AD. Cyclosporine-Induced Resolution of Choroidal Neovascularization Associated With Sympathetic Ophthalmia. Arch Ophthalmol. 1998;116(2):249–250. doi:https://doi.org/
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