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Research Letter |

Adalimumab for Pediatric Sympathetic Ophthalmia

Joon-Bom Kim, BA1; Abdallah Jeroudi, MD1; Sheila T. Angeles-Han, MD1,2,3; Hans E. Grossniklaus, MD1; Steven Yeh, MD1
[+] Author Affiliations
1Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
2Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
3Children’s Hospital of Atlanta, Atlanta, Georgia
JAMA Ophthalmol. 2014;132(8):1022-1024. doi:10.1001/jamaophthalmol.2014.426.
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Sympathetic ophthalmia (SO) is an autoimmune, bilateral, granulomatous panuveitis occurring after accidental or surgical trauma to the eye.1 Systemic corticosteroids are first-line therapy for SO, with immunomodulatory therapy used for corticosteroid-sparing immunosuppression and chronic, refractory cases. Biological response modifiers are a class of therapeutics that target specific cytokines mediating inflammation, and tumor necrosis factor α (TNF-α)–antagonist biological response modifiers have shown promise for uveitis.2 Herein, we report the first use, to our knowledge, of adalimumab for refractory pediatric SO leading to resolution of inflammation.

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Figure 1.
Histopathologic Findings of the Enucleated Specimen

The enucleated right eye contained a diffuse chronic inflammatory infiltrate in the choroid including epithelioid histiocytes forming noncaseating granulomas (A), and it also contained Dalen-Fuchs nodules (B) (hematoxylin-eosin, original magnification ×100).

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Figure 2.
Anterior Segment Photograph of the Patient’s Left Eye

A chronic, low-grade inflammation including flare and posterior synechiae persisted in the left eye when oral prednisone was tapered.

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