Sympathetic ophthalmia: a comparison of the histopathological features from a Chinese and American series

The importance of this comparison between two large series of cases of sympathetic ophthalmia lies in its confirmation of our previous findings, which differ somewhat from the classical pathological description. Sympathetic ophthalmia remains a clinicopathological diagnosis, relying on a history of perforating injury to one eye, followed after a variable incubation period by inflammation in the fellow eye. The inflammatory changes in both eyes consist of a diffuse, granulomatous proliferation throughout the uveal tract, which involves the choriocapillaris and the retina late in its course. The infiltrate is composed predominantly of lymphocytes and plasma cells, with a variable number of epitheloid and giant cells. Corticosteroid therapy may modify this picture. The epithelioid cells contain phagocytosed pigment granules, but there is not sign of necrosis. Eosinophils appear early in the course of the disease and disappear late. The granulomatous inflammation may spread to involve the optic nerve sheath, the nerve itself, the scleral emissaria, and the scleral stroma. Dalén-Fuchs nodules appear early peripherally, and it is over these nodules that retinal granulomas, when present, usually are found. In the Shanghai series, it was found that corticosteroid therapy and prompt enucleation of the exciting eye reduced the number of exacerbations experienced by these patients but did not improve visual prognosis. The MEEI data, while they did show a bimodal distribution to the visual result, seemed to indicate that prompt enucleation of a blind eye combined with aggressive corticosteroid therapy may improve visual prognosis.