Journal List > J Korean Ophthalmol Soc > v.56(2) > 1010198

J Korean Ophthalmol Soc. 2015 Feb;56(2):275-279. Korean.
Published online February 12, 2015.  https://doi.org/10.3341/jkos.2015.56.2.275
©2015 The Korean Ophthalmological Society
A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma
Yoon Mi Sung, MD, Su Kyung Jung, MD, Kyu Seop Kim, MD and Suk Woo Yang, MD, PhD
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Address reprint requests to Suk Woo Yang, MD, PhD. Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-2258-1188, Fax: 82-2-599-7405, Email: yswoph@hanmail.net
Received August 23, 2014; Revised October 23, 2014; Accepted January 07, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma.

Case summary

A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed.

Conclusions

Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.

Keywords: Meningioma; Sympathetic ophthalmia

Figures


Figure 1
(A) Corneal opacity and mid-dilated pupil in the left eye, (B) brain MRI showed progressed mass extent to orbit, ethmoid sinus, nasal cavity, sphenoid sinus, intracranium, (C) conjunctival injection in the right eye after 2 weeks, (D) KP's on endothelium and fibrinous membrane on anterior lens capsule in the right eye, (E) exudative retinal detachment and multiple granulomatous nodules in the right eye, (F, G) FAG shows multiple progressively fluorescent dots at the level of the RPE, disc leakage, coalescence of the dye, (H) patternless growth and abundant miotic figures (HE ×40). KP's = keratic precipitates; FAG = fluorescent angiography; RPE = retinal pigment epithelium.
Click for larger image


Figure 2
(A) Decreased inflammation at anterior chamber in the right eye, (B) mildly swollen disc and improved serous retinal detachment in the right eye.
Click for larger image

References
1. Albert DM, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol 1989;34:1–14.
2. Mackenzie W. In: A practical treatise on the diseases of the eye. 3rd ed. London: Longmans; 1840.
3. Makley TA Jr, Azar A. Sympathetic ophthalmia. A long-term follow-up. Arch Ophthalmol 1978;96:257–262.
4. Marak GE Jr. Recent advances in sympathetic ophthalmia. Surv Ophthalmol 1979;24:141–156.
5. Lee KS. A case report of sympathetic ophthalmia. J Korean Ophthalmol Soc 1977;18:189–195.
6. Yoon YD, Lim JO, Shin DE. A case of sympathetic ophthalmia with giant subretinal neovascular membrane. J Korean Ophthalmol Soc 1994;35:112–117.
7. Chan CC, Benezra D, Rodrigues MM, et al. Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia. Ophthalmology 1985;92:580–590.
8. Chan CC, Nussenblatt RB, Fujikawa LS, et al. Sympathetic ophthalmia. Immunopathological findings. Ophthalmology 1986;93:690–695.
9. Croxatto JO, Rao NA, McLean IW, Marak GE. Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases. Int Ophthalmol 1982;4:129–135.
10. Albert DM, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol 1989;34:1–14.
11. Bilyk JR. Enucleation, evisceration, and sympathetic ophthalmia. Curr Opin Ophthalmol 2000;11:372–386.
12. Lubin JR, Albert DM, Weinstein M. Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978). Ophthalmology 1980;87:109–121.
13. Reynard M, Riffenburgh RS, Maes EF. Effect of corticosteroid treatment and enucleation on the visual prognosis of sympathetic ophthalmia. Am J Ophthalmol 1983;96:290–294.
14. Chan CC, Roberge RG, Whitcup SM, Nussenblatt RB. 32 cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda, Md., from 1982 to 1992. Arch Ophthalmol 1995;113:597–600.
15. Nussenblatt R. Sympathetic ophthalmia. In: Nussenblatt RB SW, Palestine AG, editors. Uveitis: fundamental and clinical practice. 2nd ed. St. Louis: Mosby; 1996. pp. 97-134.pp. 311-323.
16. Vote BJ, Hall A, Cairns J, Buttery R. Changing trends in sympathetic ophthalmia. Clin Experiment Ophthalmol 2004;32:542–545.