SYMPATHETIC OPHTHALMIA - AN IMMUNOHISTOCHEMISTRY STUDY OF 4 CASES

We present histological and immunohistochemical data on four cases of sympathetic ophthalmia, a disease that is believed to occur predominan tly after perforating injury of the eye. Only a few cases without prev ious perforation have been reported. Nevertheless, sympathetic ophthal mia should be taken into consideration if then is a bilateral intraocu lar inflammation, even without trauma, as in two of our cases (cases 1 and 2). An unusual case after uneventful intracapsular cataract extra ction and a posttraumatic ''classic'' case are also presented (cases 3 and 4). We found a granulomatous infiltration of the uveal tract by l ymphocytes, plasma cells, and epithelioid cells, particularly of the c horoid. Dalen-Fuchs nodules were found in all cases, the second case a lso being associated with phacoanaphylaxis. Cases 1 and 4 showed immun ohistochemically a predominance of CD3-positive cells (T-lymphocytes), whereas in cases 2 and 3, many cells surprisingly stained positively for L26 (B-lymphocytes). In case 2 the immune response may have been a ltered by the additional phacoanaphylaxis. In all four cases, scattere d epithelioid cells stained positively for CD68, We conclude that in c ases of bilateral uveitis, even without previous penetrating injury or after common intraocular surgery, sympathetic ophthalmia as a possibl e cause should be taken into consideration because an early diagnosis with subsequent enucleation of the exciting eye is of decisive influen ce on the course of the disease.