A relatively rare eye condition known as sympathetic ophthalmia occurs when vision is lost in one eye–either through injury or multiple surgeries–and the body's overactive immune system attacks the remaining healthy eye. If the condition is not treated, the person may become completely blind. University of Iowa researchers have tested and are now using a new surgical implant to treat the otherwise healthy remaining eye. Vinit Mahajan, MD, PhD, an assistant professor and ophthalmologist at University of Iowa Hospitals and Clinics, talks about this surgical procedure and treatment:
Does everyone who accidentally loses the sight in one eye develop sympathetic ophthalmia?
No—it's hard to estimate. After an injury, maybe one out of 1,000 people get sympathetic ophthalmia; and after surgery, maybe one out of 10,000.
What are the symptoms of sympathetic ophthalmia in the healthy eye?
They can be very mild. The patient may complain of blurred vision, mild pain, tearing, light sensitivity—and again, this is in the non-injured eye. When we look in the back of the eye, we see signs of inflammation, which we call uveitis.
How is sympathetic ophthalmia commonly treated?
It's an autoimmune disease, so the first line of treatment is using heavy oral steroids to suppress the immune system, and then switching over to other different kinds of immunosuppressive drugs that are used in organ transplants. Periodically we'll use steroid injections in and around the eye.
Are there risks to the patient subjected to staying on lifelong immunosuppressive medications?
That's probably the biggest risk. Since they're taking it orally, these medicines are going around their whole body and the side effects can be pretty bad. These include diabetes, high blood pressure, osteoporosis, kidney and liver damage, alterations in mood, and so on.
What does the new surgical treatment involve?
It's a very delicate procedure that we perform under an operating microscope. It involves making an incision into the eye for a few millimeters and then we sew a very tiny implant that's a few millimeters long into the eye. It takes about an hour and we can usually do it with the patient partially awake. Pain and discomfort-wise, it's usually a Tylenol level discomfort and the patients have a pretty quick recovery.
How does the implant work?
If you saw the implant, it's about three millimeters long and a millimeter and a half wide. It looks like a piece of plastic with a small aspirin tablet on it. That aspirin tablet is a small, corticosteroid that has a slow release feature. So once that's sewn into the eye, that tablet will start releasing the medication slowly. It will last about two and one-half years, and it's providing the steroid just inside the eye, instead of flooding the entire body with this immunosuppressant medication.
The implant stays in the eye for that two and one-half years. Does it slowly work out or what happens to it?
If the surgery goes well, which is most often the case, that implant will stay inside the eye for the full two and one-half years and often can stay there forever—it's not removed. We've followed our patients for a little over two years now, and so the question for us is going to be: now that this medication implant has reached its limit, are these patients going to need an additional implant or additional treatment?
Have patients who have received the implant been able to stop taking other whole body immunosuppressives?
That's been probably the most dramatic aspect of this, is there were patients that were on these heavy-duty immunosuppressive medications. Almost all of our eight patients were able to stop them completely. There were two patients who had some recurrent inflammation, and because you're concerned about the patients going completely blind, they were started back on one of the oral immunosuppressive drugs; but at a lower dose. So overall, that's been a huge change in their lifestyle. We had some patients with very severe osteoporosis or bad hypertension, and those issues have resolved themselves. |
