Título / Title

Sympathetic Ophthalmia after Ruthenium Plaque Brachytherapy for Iris Melanoma

Introdução / Purpose

Sympathetic ophthalmia (SO) is a rare bilateral uveitis with an incidence of 0.5% following ocular trauma and 0.01% following intraocular surgery. SO after ruthenium plaque radiotherapy (RPR) is even rarer and has only been previously described in one published case report.

Material e Método / Methods

A 41 years-old white female complained of a visual deterioration in her right eye (RE) over the previous weeks. She was otherwise healthy and had a history of RPR on the left eye (LE) for an iris melanoma 3 months earlier. She had no other antecedent of ocular trauma or surgery. Her visual acuity was 6/36 on the RE and 6/9 on the LE and she had 1+ cells in the anterior chamber in both eyes (BE). The fundus revealed pink discs, with retinal folds in the posterior pole. A B-scan showed thickening of the posterior coats, compatible with posterior scleritis in BE. She was started on oral Prednisolone 60mg/day and topical steroids.

Resultados / Results

She was submitted to a Fluorescein (FFA) and Indocyanine green angiography (ICG), as well as an EDI OCT. On the FFA she had leaky optic discs bilaterally. The ICG showed multiple choroidal dark spots in the late phase, symmetric in BE. The EDI OCT showed increased choroidal thickness with 974m RE and 878 m LE. A week later, she developed multiple yellowish choroidal lesions compatible with Dalen-Fuchs nodules, and was diagnosed as SO. On follow-up she required intravenous pulse steroid therapy and the addition of Cyclosporin and Adalimumab for disease control, with choroidal quiescence after 10 months of treatment.

Discussão e Conclusões / Conclusion

SO represents an autoimmune T-cell-mediated response against uveal antigenic protein, which usually is exposed after a traumatic or surgical injury involving the uvea. The risk of developing SO after charged-particle therapy in the absence of a penetrating uveal tract injury is minimal, but possible.The typical subretinal lesions and the choroidal dark spots that improved with immunosuppression complete the clinical picture of this rare disease.

Palavras Chave

sympathetic ophthalmia
ruthenium plaque brachytherapy
iris melanoma