A Case of Sympathetic Ophthalmia After Corneal Perforation

We report a case of sympathetic ophthalmia that developed in the fellow eye following therapeutic corneal transplantation and amniotic membrane transplantation for corneal perforation caused by corneal ulceration. A 62-year-old man presented with discharge, lacrimation, and decreased visual acuity in the left eye. He was diagnosed with a corneal ulcer and treated with antimicrobial agents, but corneal epithelial erosion persisted, leading to nontraumatic corneal perforation. The patient underwent therapeutic lamellar keratoplasty and amniotic membrane transplantation, but corneal epithelial erosion remained. Subsequently, conjunctival flap surgery and tarsorrhaphy were performed. Soon after, sympathetic ophthalmia developed in the fellow eye, and pulse steroid therapy was initiated. Although recurrence occurred during steroid tapering, a second pulse steroid therapy with a gradual dosage reduction over about one year successfully prevented further recurrence. The patient completed steroid therapy with a good visual prognosis. This case highlights the development of sympathetic ophthalmia in the fellow eye after multiple surgeries for nontraumatic corneal perforation, and immediate steroid therapy proved effective.