Background: Anti-vascular endothelial growth factor (VEGF) therapy has become established as the standard treatment for exudative age-related macular degeneration (AMD). Here report a case of sympathetic ophthalmia that appeared to have been caused by the administration of multiple anti-VEGF agents for exudative AMD.
Case: A 76-year-old man presented at the Department of Ophthalmology of the Tokyo Women's Medical University Hospital with the chief complaint of decreased visual acuity in the right eye from 2 months ago. He was diagnosed with polypoidal choroidal vasculopathy in the right eye and had been undergoing treatment with intravitreal aflibercept (IVA) injections. At 3.5 years after initiating the treatment, he underwent his 25th IVA injection in his right eye. However, 1 month later, he presented at our hospital without an appointment due to decreased visual acuity in both the eyes. Retinal detachment in the macula and markedly thickened choroid were noted in both the eyes. Fluorescein angiography indicated inflammatory findings in the optic disc and choroid, whereas systemic testing revealed cerebrospinal fluid pleocytosis. While ocular and systemic findings were suggestive of Vogt-Koyanagi-Harada disease, we diagnosed the patient with sympathetic ophthalmia considering his history of undergoing IVA injections.
Conclusions: We treated a patient with sympathetic ophthalmia that developed while he was undergoing multiple anti-VEGF therapies for exudative AMD. Sympathetic ophthalmia must be considered if a patient complaints of acute bilateral visual acuity loss while undergoing treatment with anti-VEGF therapy.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 124: 713-719, 2020.
