Progress on diagnosis and treatment of sympathetic ophthalmia_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Yiming ,  Yan Hua

Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China;

Corresponding author：

Yan Hua, Email: phuayan2000@163.com

Keywords：

Ophthalmia, sympathetic/diagnosis; Ophthalmia, sympathetic/therapy; Review

DOI：

10.3760/cma.j.cn511434-20190507-00168

Video：

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Abstract Full text Figures/Tables Video References Cited by

Sympathetic ophthalmia (SO) is a bilateral granulomatous uveitis that occurs after single eye surgery or internal eye surgery. Its pathogenesis is not yet clear, and it is mostly considered to be an immune disease caused by exposure to autoantigens. The clinical diagnosis mainly depends on the patient's medical history, typical clinical manifestations and signs, and auxiliary ophthalmic imaging examinations such as FFA, ICGA, OCT. The clinical manifestations of SO are complex and variable, and the disease is prone to relapse, which may eventually lead to blindness. At present, treatment is mainly through systemic glucocorticoid therapy combined with immunosuppressive agents and/or biological agents. Understanding the typical imaging manifestations of SO is helpful to confirm the diagnosis early in the clinic, and timely provide reasonable drug treatment to improve the prognosis of patients.

Citation： Li Yiming, Yan Hua. Progress on diagnosis and treatment of sympathetic ophthalmia. Chinese Journal of Ocular Fundus Diseases, 2020, 36(9): 730-734. doi: 10.3760/cma.j.cn511434-20190507-00168 Copy

1.	Kilmartin DJ, Dick AD, Forrester JV. Prospective surveillance of sympathetic ophthalmia in the UK and republic of Ireland[J]. Br J Ophthalmol, 2000, 84(3): 259-263. DOI: 10.1136/bjo.84.3.259.
2.	Wang Y, Chan CC. Gender differences in vogt-koyanagi-harada disease and sympathetic ophthalmia[J/OL]. J Ophthalmol, 2014, 2014: 157803[2014-03-05]. https://pubmed.ncbi.nlm.nih.gov/24734166/. DOI:10.1155/2014/157803.
3.	Albahlal A, Al Dhibi H, Al Shahwan S, et al. Sympathetic ophthalmia following diode laser cyclophotocoagulation[J]. Br J Ophthalmol, 2014, 98(8): 1101-1106. DOI: 10.1136/bjophthalmol-2013-304257.
4.	Brour J, Desjardins L, Lehoang P, et al. Sympathetic ophthalmia after proton beam irradiation for choroidal melanoma[J]. Ocul Immunol Inflamm, 2012, 20(4): 273-276. DOI: 10.3109/09273948.2012.689072.
5.	Viswanathan D, Haider AS, Dunlop A, et al. Sympathetic ophthalmia associated with untreated choroidal melanoma[J]. Can J Ophthalmol, 2018, 53(5): 173-176. DOI:10.1016/j.jcjo.2017.11.013.
6.	Rahman Z, Ali S, Dutta Majumder P. Sympathetic ophthalmia following accidental burn with hot water involving the other eye[J]. Ocul Immunol Inflamm, 2018, 26(8): 1225-1227. DOI: 10.1080/09273948.2017.1340960.
7.	Margo CE, Harman LE. Autoimmune disease: conceptual history and contributions of ocular immunology[J]. Surv Ophthalmol, 2016, 61(5): 680-688. DOI: 10.1016/j.survophthal.2016.04.006.
8.	黄欣, 赵培泉, 王文吉. 玻璃体手术后交感性眼炎的临床及病理学观察[J]. 中华眼底病杂志, 2007, 23(2): 112-114.Huang X, Zhao PQ, Wang WJ. Clinical and histopathological observations on sympathetic ophthalmia after vitrectomy[J]. Chin J Ocul Fundus Dis, 2007, 23(2): 112-114.
9.	Leal I, Sousa DC, Loureiro C, et al. Sympathetic ophthalmia related to conjunctival invasive squamous-cell carcinoma[J]. Indian J Ophthalmol, 2017, 65(8): 741-743. DOI: 10.4103/ijo.IJO_983_16.
10.	Abu El-Asrar AM, Struyf S, Van Den Broeck C, et al. Expression of chemokines and gelatinase B in sympathetic ophthalmia[J]. Eye (Lond), 2007, 21(5): 649-657. DOI: 10.1038/sj.eye.6702342.
11.	Furusato E, Shen D, Cao X, et al. Inflammatory cytokine and chemokine expression in sympathetic ophthalmia: a pilot study[J]. Histol Histopathol, 2011, 26(9): 1145-1151. DOI: 10.14670/hh-26.1145.
12.	Kaneko Y, Rao NA. Mitochondrial oxidative stress initiates visual loss in sympathetic ophthalmia[J]. Jpn J Ophthalmol, 2012, 56(3): 191-197. DOI: 10.1007/s10384-012-0132-9.
13.	Kaneko Y, Wu GS, Saraswathy S, et al. Immunopathologic processes in sympathetic ophthalmia as signified by microRNA profiling[J]. Invest Ophthalmol Vis Sci, 2012, 53(7): 4197-4204. DOI: 10.1167/iovs.12-9465.
14.	Kilmartin DJ, Wilson D, Liversidge J, et al. Immunogenetics and clinical phenotype of sympathetic ophthalmia in British and Irish patients[J]. Br J Ophthalmol, 2001, 85(3): 281-286. DOI: 10.1136/bjo.85.3.281.
15.	Deng J, Hu J, Tan H, et al. Association of a PDCD1 polymorphism with sympathetic ophthalmia in Han Chinese[J]. Invest Ophthalmol Vis Sci, 2017, 58(10): 4218-4222. DOI: 10.1167/iovs.17-22195.
16.	Yang W, Li H, Chen PW, et al. PD-L1 expression on human ocular cells and its possible role in regulating immune-mediated ocular inflammation[J]. Invest Ophthalmol Vis Sci, 2009, 50(1): 273-280. DOI: 10.1167/iovs.08-2397.
17.	Wang X, Wu M, Cao Y, et al. Exploring the role of programmed cell death protein 1 and its ligand 1 in eye diseases[J]. Crit Rev Clin Lab Sci, 2019, 56(1): 18-32. DOI: 10.1080/10408363.2018.1522292.
18.	Chaithanyaa N, Devireddy SK, Kishore Kumar RV, et al. Sympathetic ophthalmia: a review of literature[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(2): 172-176. DOI: 10.1016/j.tripleo.2011.01.036.
19.	Chang GC, Young LH. Sympathetic ophthalmia[J]. Semin Ophthalmol, 2011, 26(4-5): 316-320. DOI: 10.3109/08820538.2011.588658.
20.	Hansen BA, Soukiasian SH. Approach to the laboratory, imaging, and molecular work-up for uveitis[J]. Uveitis, 2017(2): 9-34. DOI: 10.1007/978-3-319-09126-6_2.
21.	Yang P, Liu S, Zhong Z, et al. Comparison of clinical features and visual outcome between sympathetic ophthalmia and Vogt-Koyanagi-Harada disease in Chinese patients[J]. Ophthalmology, 2019, 126(9): 1297-1305. DOI: 10.1016/j.ophtha.2019.03.049.
22.	Yang P, Ren Y, Li B, et al. Clinical characteristics of Vogt-Koyanagi-Harada syndrome in Chinese patients[J]. Ophthalmology, 2007, 114(3): 606-614. DOI: 10.1016/j.ophtha.2006.07.040.
23.	Dutta Majumder P, Palkar A, Annamalai R, et al. Laboratory investigations in uveitis: current practice and future directions[J]. Can J Ophthalmol, 2018, 53(3): 193-198. DOI: 10.1016/j.jcjo.2018.02.003.
24.	Samy A, Lightman S, Ismetova F, et al. Role of autofluorescence in inflammatory/infective diseases of the retina and choroid[J/OL]. J Ophthalmol, 2014, 2014: 418193[2014-04-01]. https://pubmed.ncbi.nlm.nih.gov/24800061/. DOI: 10.1155/2014/418193.
25.	Fleischman D, Say EA, Wright JD, et al. Multimodality diagnostic imaging in a case of sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2012, 20(4): 300-302. DOI: 10.3109/09273948.2012.682637.
26.	von Ruckmann A, Fitzke FW, Fan J, et al. Abnormalities of fundus autofluorescence in central serous retinopathy[J]. Am J Ophthalmol, 2002, 133(6): 780-786. DOI: 10.1016/s0002-9394(02)01428-9.
27.	Castiblanco C, Adelman RA. Imaging for sympathetic ophthalmia: impact on the diagnosis and management[J]. Int Ophthalmol Clin, 2012, 52(4): 173-181. DOI: 10.1097/ⅡO.0b013e318265d5c7.
28.	Muakkassa NW, Witkin AJ. Spectral-domain optical coherence tomography of sympathetic ophthalmia with Dalen-Fuchs nodules[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 610-612. DOI: 10.3928/23258160-20141008-01.
29.	Gupta V, Gupta A, Dogra MR, et al. Reversible retinal changes in the acute stage of sympathetic ophthalmia seen on spectral domain optical coherence tomography[J]. Int Ophthalmol, 2011, 31(2): 105-110. DOI: 10.1007/s10792-011-9432-1.
30.	Dell'arti L, Barteselli G, Invernizzi A, et al. Morphological appearance of type Ⅲ Dalen-Fuchs nodules by SD-OCT[J]. Retina, 2017, 37(5): 48-49. DOI:10.1097/iae.0000000000001476.
31.	Reynard M, Riffenburgh RS, Minckler DS. Morphological variation of Dalen-Fuchs nodules in sympathetic ophthalmia[J]. Br J Ophthalmol, 1985, 69(3): 197-201. DOI: 10.1136/bjo.69.3.197.
32.	Behdad B, Rahmani S, Montahaei T, et al. Enhanced depth imaging OCT (EDI-OCT) findings in acute phase of sympathetic ophthalmia[J]. Int Ophthalmol, 2015, 35(3): 433-439. DOI: 10.1007/s10792-015-0058-6.
33.	Brar M, Sharma M, Grewal SPS, et al. Treatment response in sympathetic ophthalmia as assessed by widefield OCT angiography[J]. Ophthalmic Surg Lasers Imaging Retina, 2018, 49(9): 726-730. DOI: 10.3928/23258160-20180831-13.
34.	Albert DM, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology[J]. Surv Ophthalmol, 1989, 34(1): 1-14. DOI: 10.1016/0039-6257(89)90125-2.
35.	Manandhar A. Sympathetic ophthalmia: enucleation or evisceration?[J]. Nepal J Ophthalmol, 2011, 3(2): 181-187. DOI: 10.3126/nepjoph.v3i2.5274.
36.	Vote BJ, Hall A, Cairns J, et al. Changing trends in sympathetic ophthalmia[J]. Clin Exp Ophthalmol, 2004, 32(5): 542-545. DOI: 10.1111/j.1442-9071.2004.00876.x.
37.	Sandinha MT, Lake S. Periocular injections of triamcinolone for sympathetic ophthalmia[J]. Clin Exp Ophthalmol, 2010, 38(8): 819-821. DOI: 10.1111/j.1442-9071.2010.02350.x.
38.	Jonas JB. Intravitreal triamcinolone acetonide for treatment of sympathetic ophthalmia[J]. Am J Ophthalmol, 2004, 137(2): 367-368. DOI: 10.1016/s0002-9394(03)00899-7.
39.	Mahajan VB, Gehrs KM, Goldstein DA, et al. Management of sympathetic ophthalmia with the fluocinolone acetonide implant[J]. Ophthalmology, 2009, 116(3): 552-557. DOI: 10.1016/j.ophtha.2008.10.024.
40.	Callanan DG, Jaffe GJ, Martin DF, et al. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results[J]. Arch Ophthalmol, 2008, 126(9): 1191-1201. DOI: 10.1001/archopht.126.9.1191.
41.	Almeida DR, Chin EK, Mears K, et al. Spontaneous dislocation of a fluocinolone acetonide implant (Retisert) into the anterior chamber and its successful extraction in sympathetic ophthalmia[J]. Retin Cases Brief Rep, 2015, 9(2): 142-144. DOI: 10.1097/icb.0000000000000119.
42.	Mansour AM. Dexamethasone implant as sole therapy in sympathetic ophthalmia[J]. Case Rep Ophthalmol, 2018, 9(2): 257-263. DOI: 10.1159/000488850.
43.	Tan XL, Seen S, Dutta Majumder P, et al. Analysis of 130 cases of sympathetic ophthalmia - a retrospective multicenter case series[J]. Ocul Immunol Inflamm, 2019, 27(8): 1259-1266. DOI: 10.1080/09273948.2018.1517894.
44.	Hiyama T, Harada Y, Kiuchi Y. Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab[J]. Am J Ophthalmol Case Rep, 2019, 14: 1-4. DOI: 10.1016/j.ajoc.2019.01.009.

1. Kilmartin DJ, Dick AD, Forrester JV. Prospective surveillance of sympathetic ophthalmia in the UK and republic of Ireland[J]. Br J Ophthalmol, 2000, 84(3): 259-263. DOI: 10.1136/bjo.84.3.259.
2. Wang Y, Chan CC. Gender differences in vogt-koyanagi-harada disease and sympathetic ophthalmia[J/OL]. J Ophthalmol, 2014, 2014: 157803[2014-03-05]. https://pubmed.ncbi.nlm.nih.gov/24734166/. DOI:10.1155/2014/157803.
3. Albahlal A, Al Dhibi H, Al Shahwan S, et al. Sympathetic ophthalmia following diode laser cyclophotocoagulation[J]. Br J Ophthalmol, 2014, 98(8): 1101-1106. DOI: 10.1136/bjophthalmol-2013-304257.
4. Brour J, Desjardins L, Lehoang P, et al. Sympathetic ophthalmia after proton beam irradiation for choroidal melanoma[J]. Ocul Immunol Inflamm, 2012, 20(4): 273-276. DOI: 10.3109/09273948.2012.689072.
5. Viswanathan D, Haider AS, Dunlop A, et al. Sympathetic ophthalmia associated with untreated choroidal melanoma[J]. Can J Ophthalmol, 2018, 53(5): 173-176. DOI:10.1016/j.jcjo.2017.11.013.
6. Rahman Z, Ali S, Dutta Majumder P. Sympathetic ophthalmia following accidental burn with hot water involving the other eye[J]. Ocul Immunol Inflamm, 2018, 26(8): 1225-1227. DOI: 10.1080/09273948.2017.1340960.
7. Margo CE, Harman LE. Autoimmune disease: conceptual history and contributions of ocular immunology[J]. Surv Ophthalmol, 2016, 61(5): 680-688. DOI: 10.1016/j.survophthal.2016.04.006.
8. 黄欣, 赵培泉, 王文吉. 玻璃体手术后交感性眼炎的临床及病理学观察[J]. 中华眼底病杂志, 2007, 23(2): 112-114.Huang X, Zhao PQ, Wang WJ. Clinical and histopathological observations on sympathetic ophthalmia after vitrectomy[J]. Chin J Ocul Fundus Dis, 2007, 23(2): 112-114.
9. Leal I, Sousa DC, Loureiro C, et al. Sympathetic ophthalmia related to conjunctival invasive squamous-cell carcinoma[J]. Indian J Ophthalmol, 2017, 65(8): 741-743. DOI: 10.4103/ijo.IJO_983_16.
10. Abu El-Asrar AM, Struyf S, Van Den Broeck C, et al. Expression of chemokines and gelatinase B in sympathetic ophthalmia[J]. Eye (Lond), 2007, 21(5): 649-657. DOI: 10.1038/sj.eye.6702342.
11. Furusato E, Shen D, Cao X, et al. Inflammatory cytokine and chemokine expression in sympathetic ophthalmia: a pilot study[J]. Histol Histopathol, 2011, 26(9): 1145-1151. DOI: 10.14670/hh-26.1145.
12. Kaneko Y, Rao NA. Mitochondrial oxidative stress initiates visual loss in sympathetic ophthalmia[J]. Jpn J Ophthalmol, 2012, 56(3): 191-197. DOI: 10.1007/s10384-012-0132-9.
13. Kaneko Y, Wu GS, Saraswathy S, et al. Immunopathologic processes in sympathetic ophthalmia as signified by microRNA profiling[J]. Invest Ophthalmol Vis Sci, 2012, 53(7): 4197-4204. DOI: 10.1167/iovs.12-9465.
14. Kilmartin DJ, Wilson D, Liversidge J, et al. Immunogenetics and clinical phenotype of sympathetic ophthalmia in British and Irish patients[J]. Br J Ophthalmol, 2001, 85(3): 281-286. DOI: 10.1136/bjo.85.3.281.
15. Deng J, Hu J, Tan H, et al. Association of a PDCD1 polymorphism with sympathetic ophthalmia in Han Chinese[J]. Invest Ophthalmol Vis Sci, 2017, 58(10): 4218-4222. DOI: 10.1167/iovs.17-22195.
16. Yang W, Li H, Chen PW, et al. PD-L1 expression on human ocular cells and its possible role in regulating immune-mediated ocular inflammation[J]. Invest Ophthalmol Vis Sci, 2009, 50(1): 273-280. DOI: 10.1167/iovs.08-2397.
17. Wang X, Wu M, Cao Y, et al. Exploring the role of programmed cell death protein 1 and its ligand 1 in eye diseases[J]. Crit Rev Clin Lab Sci, 2019, 56(1): 18-32. DOI: 10.1080/10408363.2018.1522292.
18. Chaithanyaa N, Devireddy SK, Kishore Kumar RV, et al. Sympathetic ophthalmia: a review of literature[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(2): 172-176. DOI: 10.1016/j.tripleo.2011.01.036.
19. Chang GC, Young LH. Sympathetic ophthalmia[J]. Semin Ophthalmol, 2011, 26(4-5): 316-320. DOI: 10.3109/08820538.2011.588658.
20. Hansen BA, Soukiasian SH. Approach to the laboratory, imaging, and molecular work-up for uveitis[J]. Uveitis, 2017(2): 9-34. DOI: 10.1007/978-3-319-09126-6_2.
21. Yang P, Liu S, Zhong Z, et al. Comparison of clinical features and visual outcome between sympathetic ophthalmia and Vogt-Koyanagi-Harada disease in Chinese patients[J]. Ophthalmology, 2019, 126(9): 1297-1305. DOI: 10.1016/j.ophtha.2019.03.049.
22. Yang P, Ren Y, Li B, et al. Clinical characteristics of Vogt-Koyanagi-Harada syndrome in Chinese patients[J]. Ophthalmology, 2007, 114(3): 606-614. DOI: 10.1016/j.ophtha.2006.07.040.
23. Dutta Majumder P, Palkar A, Annamalai R, et al. Laboratory investigations in uveitis: current practice and future directions[J]. Can J Ophthalmol, 2018, 53(3): 193-198. DOI: 10.1016/j.jcjo.2018.02.003.
24. Samy A, Lightman S, Ismetova F, et al. Role of autofluorescence in inflammatory/infective diseases of the retina and choroid[J/OL]. J Ophthalmol, 2014, 2014: 418193[2014-04-01]. https://pubmed.ncbi.nlm.nih.gov/24800061/. DOI: 10.1155/2014/418193.
25. Fleischman D, Say EA, Wright JD, et al. Multimodality diagnostic imaging in a case of sympathetic ophthalmia[J]. Ocul Immunol Inflamm, 2012, 20(4): 300-302. DOI: 10.3109/09273948.2012.682637.
26. von Ruckmann A, Fitzke FW, Fan J, et al. Abnormalities of fundus autofluorescence in central serous retinopathy[J]. Am J Ophthalmol, 2002, 133(6): 780-786. DOI: 10.1016/s0002-9394(02)01428-9.
27. Castiblanco C, Adelman RA. Imaging for sympathetic ophthalmia: impact on the diagnosis and management[J]. Int Ophthalmol Clin, 2012, 52(4): 173-181. DOI: 10.1097/ⅡO.0b013e318265d5c7.
28. Muakkassa NW, Witkin AJ. Spectral-domain optical coherence tomography of sympathetic ophthalmia with Dalen-Fuchs nodules[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 610-612. DOI: 10.3928/23258160-20141008-01.
29. Gupta V, Gupta A, Dogra MR, et al. Reversible retinal changes in the acute stage of sympathetic ophthalmia seen on spectral domain optical coherence tomography[J]. Int Ophthalmol, 2011, 31(2): 105-110. DOI: 10.1007/s10792-011-9432-1.
30. Dell'arti L, Barteselli G, Invernizzi A, et al. Morphological appearance of type Ⅲ Dalen-Fuchs nodules by SD-OCT[J]. Retina, 2017, 37(5): 48-49. DOI:10.1097/iae.0000000000001476.
31. Reynard M, Riffenburgh RS, Minckler DS. Morphological variation of Dalen-Fuchs nodules in sympathetic ophthalmia[J]. Br J Ophthalmol, 1985, 69(3): 197-201. DOI: 10.1136/bjo.69.3.197.
32. Behdad B, Rahmani S, Montahaei T, et al. Enhanced depth imaging OCT (EDI-OCT) findings in acute phase of sympathetic ophthalmia[J]. Int Ophthalmol, 2015, 35(3): 433-439. DOI: 10.1007/s10792-015-0058-6.
33. Brar M, Sharma M, Grewal SPS, et al. Treatment response in sympathetic ophthalmia as assessed by widefield OCT angiography[J]. Ophthalmic Surg Lasers Imaging Retina, 2018, 49(9): 726-730. DOI: 10.3928/23258160-20180831-13.
34. Albert DM, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology[J]. Surv Ophthalmol, 1989, 34(1): 1-14. DOI: 10.1016/0039-6257(89)90125-2.
35. Manandhar A. Sympathetic ophthalmia: enucleation or evisceration?[J]. Nepal J Ophthalmol, 2011, 3(2): 181-187. DOI: 10.3126/nepjoph.v3i2.5274.
36. Vote BJ, Hall A, Cairns J, et al. Changing trends in sympathetic ophthalmia[J]. Clin Exp Ophthalmol, 2004, 32(5): 542-545. DOI: 10.1111/j.1442-9071.2004.00876.x.
37. Sandinha MT, Lake S. Periocular injections of triamcinolone for sympathetic ophthalmia[J]. Clin Exp Ophthalmol, 2010, 38(8): 819-821. DOI: 10.1111/j.1442-9071.2010.02350.x.
38. Jonas JB. Intravitreal triamcinolone acetonide for treatment of sympathetic ophthalmia[J]. Am J Ophthalmol, 2004, 137(2): 367-368. DOI: 10.1016/s0002-9394(03)00899-7.
39. Mahajan VB, Gehrs KM, Goldstein DA, et al. Management of sympathetic ophthalmia with the fluocinolone acetonide implant[J]. Ophthalmology, 2009, 116(3): 552-557. DOI: 10.1016/j.ophtha.2008.10.024.
40. Callanan DG, Jaffe GJ, Martin DF, et al. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results[J]. Arch Ophthalmol, 2008, 126(9): 1191-1201. DOI: 10.1001/archopht.126.9.1191.
41. Almeida DR, Chin EK, Mears K, et al. Spontaneous dislocation of a fluocinolone acetonide implant (Retisert) into the anterior chamber and its successful extraction in sympathetic ophthalmia[J]. Retin Cases Brief Rep, 2015, 9(2): 142-144. DOI: 10.1097/icb.0000000000000119.
42. Mansour AM. Dexamethasone implant as sole therapy in sympathetic ophthalmia[J]. Case Rep Ophthalmol, 2018, 9(2): 257-263. DOI: 10.1159/000488850.
43. Tan XL, Seen S, Dutta Majumder P, et al. Analysis of 130 cases of sympathetic ophthalmia - a retrospective multicenter case series[J]. Ocul Immunol Inflamm, 2019, 27(8): 1259-1266. DOI: 10.1080/09273948.2018.1517894.
44. Hiyama T, Harada Y, Kiuchi Y. Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab[J]. Am J Ophthalmol Case Rep, 2019, 14: 1-4. DOI: 10.1016/j.ajoc.2019.01.009.

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