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Sympathetic ophthalmia following radiation-induced scleral necrosis in choroidal melanoma
Yen-Cheng Chen1, Yu-Jang Chao2, Chieh-Chih Tsai3, Shih-Jen Chen3, De-Kuang Hwang3
1 Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
2 School of Medicine, National Yang Ming Chiao Tung University; Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
3 Department of Ophthalmology, Taipei Veterans General Hospital; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Correspondence Address:
De-Kuang Hwang,
Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217
Taiwan
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/2211-5056.360046
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Sympathetic ophthalmia (SO) is a bilateral granulomatous panuveitis. We report a rare case of SO presenting after scleral necrosis as a late complication of Gamma Knife radiotherapy for choroidal melanoma. A 55-year-old woman presented with primary choroidal melanoma in the right eye and has been treated with Gamma Knife radiotherapy with stable tumor size. Five years after radiotherapy, a pigmented protrusive uveal mass was visibly noted over the superior sclera of the same eye, corresponding to periocular soft tissue enhancement on computed tomography. Biopsies of the pigmented mass showed the absence of malignancy. One month later, acute blurred vision with signs of sympathetic ophthalmia developed in the left eye. The patient received high-dose systemic corticosteroids and immunomodulatory therapy. The intraocular inflammation in the left eye subsided with improving vision, and the uveal mass in the right eye flattened after the anti-inflammatory therapy. Scleral necrosis is a rare complication following radiotherapy for choroidal melanoma and may incite sympathetic ophthalmia, for which prompt and aggressive treatment is important to save vision, especially for the fellow eye.
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