Sympathetic ophthalmia after pars plana vitrectomy-lensectomy for endogenous bacterial endophthalmitis

A 71-year-old woman developed an endogenous bacterial endophthalmitis in her right eye. Because of the rapid progression she was treated by para plana vitrectomy-lensectomy and with antibiotics and corticosteroids. The patient improved after the antibiotic therapy. One month later she had a recurrence of the inflammatory signs in the same eye. Examination disclosed lens remnants in the vitreous. Because of the possibility of phacoallergic uveitis, she underwent a second vitrectomy. The corticosteroid dosage was increased. She did well until three months later when, while still taking corticosteroids, she noted loss of visual acuity in the left eye, accompanied by bilateral inflammatory signs. Sympathetic ophthalmia was suspected and the blind right eye was enucleated. The choroid was grossly unremarkable; the routine sections disclosed many inconspicuous foci of mononuclear infiltration. Tangential sections of flat-embedded choroid, however, showed ill-defined nests of epithelioid cells containing phagocytosed melanin, supporting the diagnosis of sympathetic ophthalmia. To our knowledge, this is the first published report of this complication after pars plana vitrectomy-lensectomy in the absence of nonsurgical trauma or other surgical procedures.