Sympathetic Ophthalmia Following Vitrectomy for Myopic Traction Maculopathy: Clinical and Imaging Correlates Supporting a Melanophage-Mediated Immune Response.

PURPOSE: To describe a case of sympathetic ophthalmia following vitreoretinal surgery for myopic traction maculopathy, highlighting novel clinical findings that provide in vivo support for a melanophage-mediated immune mechanism. METHODS: Observational case report. RESULTS: A 26-year-old high-myopic female developed bilateral granulomatous panuveitis four weeks after pars plana vitrectomy and fluid-gas exchange for myopic traction maculopathy OD. Clinical examination revealed bilateral mutton-fat keratic precipitates and vitreous cells, more severe OD. Prominent pigment within granulomatous keratic precipitates and pigment-laden cells posterior to the crystalline lens were also observed OU. View of the posterior segment in OD was poor. Multifocal yellowish choroid lesions (Dalen Fuchs nodules) were present in OS. Optical coherence tomography only possible in OS demonstrated bacillary layer detachment, subretinal fluid, and marked choroidal thickening. Cerebrospinal fluid analysis revealed marked leukocytic pleocytosis. Sympathetic ophthalmia (SO) was diagnosed. Following prompt initiation of high-dose systemic corticosteroids and steroid-sparing immunosuppression, bilateral ocular inflammation resolved with normalization of choroidal thickness. CONCLUSIONS: Dense hyperpigmented clumps within keratic precipitates and pigment-laden cells in the posterior segment consistent with melanophage activity, support the histopathological hallmark of sympathetic ophthalmia, in which macrophages phagocytose liberated uveal melanocytes.