Phacoanaphylactic endophthalmitis as sympathetic ophthalmia after corneoscleral injury

Abstract

A penetrating corneoscleral injury case with the development of bilateral phacoanaphylactic inflammation of a sympathetic ophthalmia kind in a 59-year-old woman is described. The case reveals a difference between bilateral phacoanaphylactic inflammation and classical sympathetic ophthalmia. Unlike the latter, the clinical case showed on the “healthy” eye a sluggish inflammation of anterior uveitis type with a slowly progressing lens opacity, for which local and systemic corticosteroid therapy proved insufficiently effective. The morphological picture showed that the inflammation was located in the anterior part of the eye around the damaged lens with the formation of a macrophage-neutrophil abscess, which is typical for phacoanaphylactic inflammation, and the absence of granulomatous inflammation in the ciliary body, where plasmacellular infiltration prevailed.Conclusions. Phacoanaphylactic inflammation and sympathetic inflammation are autoimmune in their nature having different autoantigens. In phacoanaphylactic inflammation, autoantigen is the lens protein, while in sympathetic inflammation it is the uveoretinal antigen. The only method of treating phacoanaphylactic inflammation is to remove the cataract-altered lens. Our patient underwent phacoemulsification in her single eye, after which the symptoms of uveitis with hypertension disappeared completely and her vision was restored.