Atlas of Ophthalmology

Dalen-Fuchs nodules in Sympathetic Ophthalmia (Colour Photography Posterior Segment, SD-OCT, FFA)

脉络膜 -> Inflammatory Diseases -> Sympathetic Ophthalmia (SO)
Patient: 55 years of age, female, BCVA 0.5 at OD, No light at OS. Ocular Medical History: decrease of vision in the healthy fellow eye (OD) 5 months after pars plana vitrectomy to the diseased eye (OS). OS blinded after pars plana vitrectomy with silicon installation in 02/2014 and 06/2014. In 09/2013 a retinal laser treatment was performed in OS due to a retinal break. Sympathetic ophthalmia was diagnosed after a negative systemic work-up. General Medical History: arterial hypertension. Main Complaint: decrease of vision in healthy fellow eye (OD). Purpose: to present chorioretinal lesions in healthy fellow eye (OD) after pars plana vitrectomy with silicon installation in the primarily diseased eye (OS). Methods: Colour Photography Posterior Segment, OCT, FFA. Findings: Colour Photography Posterior Segment: vitritis and subretinal lesions consistent with Dalen-Fuchs nodules. SD-OCT: hyper-reflective lesions at the level of the retinal pigment epithelium with disruption of the inner segment/outer segment (IS/OS) junction. FFA, early phase: hypofluorescence seen in the lesion by an intact retinal pigment epithelium over the Dalen-Fuchs nodule. FFA, late Phase: staining in the late phase of the fluorescein angiogram by accumulation of fluorescein into the presumed Dalen-Fuchs nodule. Discussion: Sharp et al (1) performed a histopathologic examination in sympathetic ophthalmia found 15 months after cataract extraction in a previously traumatized eye. His histopathologic examination disclosed numerous Dalen-Fuchs nodules with underlying choroidal granulomas causing obliteration of the choriocapillaris and disruption of Bruch's membrane. The angiographic findings of initial hypofluorescence followed by late hyperfluorescence correlated with the pathologic findings. Literature: (1) Sharp DC, Bell RA, Patterson E, Pinkerton RM. Sympathetic ophthalmia. Histopathologic and fluorescein angiographic correlation. Arch Ophthalmol.1984 Feb;102(2):232-5.

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