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High definition spectral domain optical coherence tomography of retinal pigment epithelial rip in a case of sympathetic ophthalmia
© Mahendradas et al.; licensee Springer. 2013
Received: 11 September 2012
Accepted: 12 September 2012
Published: 21 January 2013
We are reporting a case of granulomatous panuveitis in the right eye following penetrating injury to the left eye.
A 34-year-old female was diagnosed to have sympathetic ophthalmia on treatment with systemic steroids. Vision did not improve in spite of aggressive systemic steroid therapy. On examination, patient had large retinal pigment epithelial rip nasal to the disc with exudative retinal detachment which was documented with FFA, ICG, and OCT. RPE rip is responsible for the persistent exudative retinal detachment in the right eye.
RPE rip can cause decreased vision due to persistence of retinal detachment in a case of sympathetic ophthalmia.
Sympathetic ophthalmia (SO) is a bilateral granulomatous panuveitis in which the sympathising eye suffers granulomatous panuveitis after penetrating injury to the fellow eye . We report a case of SO with retinal pigment epithelial (RPE) rip documented with high definition spectral domain optical coherence tomography (OCT). Informed consent was obtained from the patient for publication.
Institutional ethics committee approval was obtained for the study of a 34-year-female diagnosed to have right eye SO since 1 month presented to us with insignificant improvement of vision in the right eye despite treatment with systemic steroids for 4 weeks. She stated a history of trauma to the left eye 3 months back and had undergone enucleation of the injured eye on the 17th day after the injury.
Reversible retinal changes such as serous retinal detachment and elongation of photoreceptors have been reported  in the acute stage of SO on spectral domain optical coherence tomography. Some other changes reported include disorganisation and thinning of the inner retina, and pronounced disintegration of the RPE and choriocapillaries (‘waterfall effect’) . Peripheral rips have been reported to occur following uveal effusion syndrome , panuveitis, trauma and acute retinal necrosis . Mechanical stretching of the RPE secondary to choroidal swelling has been suggested as the mechanism of rips due to many choroidal effusions . Sympathetic ophthalmia is associated with granulomatous inflammation of the choroid with significant increase in choroidal thickness. We hypothesise that a similar stretching mechanism of the RPE had a role to play in the rip seen in our case. We also believe that the pigment epithelial rip may itself have caused some exudative detachment owing to a loss of the RPE barrier function  in addition to that caused by the primary disease, thus complicating both the clinical picture and the anatomic and visual recovery despite adequate treatment.
RPE rip is an irreversible change in sympathetic ophthalmia in addition to acute reversible retinal changes. Medline search did not reveal the report of RPE rip in sympathetic ophthalmia earlier.
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