Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report

This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophthalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema.