Presumed Sympathetic Ophthalmia After Diode Laser Cyclophotocoagulation for Neovascular Glaucoma: A Case Series.

Abstract

Purpose: To describe a case series of presumed Sympathetic Ophthalmia (SO) triggered by diode laser cyclophotocoagulation (CPC) for the treatment of neovascular glaucoma.

Methods: Patients developing bilateral granulomatous uveitis after CPC between 2014 and 2024. Cases with prior ocular trauma or penetrating ocular surgery were excluded. Treatment consisted of systemic steroids acutely and subsequently steroid-sparing drugs for long-term control.

Results: Three patients were included. The cause of neovascular glaucoma in the inciting eyes was a central retinal vein occlusion. The ocular inflammation was characterised by vitritis, serous retinal detachment, and choroidal thickening. The follow-up for each case was 2, 6 and 10 years, respectively. During this period, all patients remained under constant immunosuppression due to recurrence of inflammation while attempting tapering of systemic therapy after a period of clinical stability. The final best-corrected visual acuity of the sympathising eyes was ≥6/9 Snellen and there was no perception of light in the inciting eyes. The blind eyes were comfortable and did not require surgical removal.

Conclusions: Patients responded well to prompt immunosuppression and preserved vision in the sympathising eye. Steroid-sparing medication could not be stopped due to inflammation flare-ups and risk of visual loss. There could be a potential link between breakdown of the blood-retina barrier prior to the development of SO and sustained inflammatory reaction.