Sympathetic ophthalmia after proton beam irradiation for choroïdal melanoma

To determine the incidence and to discuss pathogenic mechanisms of sympathetic ophthalmia in patients treated for choroïdal melanoma.

Retrospective.

We analyzed the clinical and pathological data of 4867 patients, treated for choroïdal melanoma at Institute Curie-Orsay, between 1998 and 2011. Were involved patients with uveitis of the adelphe eye filling clinical and angiographic criteria of sympathetic ophthalmia. Extensive work-up was undertaken to rule out another etiology of the inflammation.

Three patients developed sympathetic ophthalmia respectively 7, 4 and 3 years after protontherapy.The incidence of this complication was 6.1 per 10000 patients treated by proton beam radiation. Ocular perforating injury was ruled out and radioactive effect of treatment was incriminated in the occurrence of sympathetic ophthalmia.

Sympathetic ophthalmia remains a rare complication which must be treated promptly and aggressively to prevent blindness.Proton beam irradiation could induce disruption of uveal tissue which enhances auto immune reactions.