BOSU's new digital system will run the first study on sympathetic ophthalmia

  • 17 Mar 2023
  • RCOphth

This month the BOSU is launching a new digital system that will replace the monthly yellow cards and postal questionnaires with an integrated email and online surveillance system.

The first study for surveillance will be sympathetic ophthalmia run by Mr Mahi Muqit of Moorfields Eye Hospital. This is a fitting topic as SO was also one of the first ever topics back in 1997.

Sympathetic Ophthalmia (SO) is a very rare but important and potentially blinding complication of surgery and ocular trauma. The underlying pathophysiological mechanisms of SO implicate an autoimmune inflammatory response against ocular antigens exposed to the lymphatic system due to the breakdown of the blood-retinal barrier or subclinical uveal incarceration at wound sites.

BOSU Case Definition

Any patient presenting to an ophthalmologist with new onset bilateral, non-necrotising, diffuse granulomatous panuveitis affecting the fellow, sympathising eye following ocular surgery, trauma or laser therapy to the inciting/exciting eye.

Signs of Sympathetic Ophthalmia

The injured eye and sympathising eye exhibit low-grade uveitis, iris thickening, and the pupil is unresponsive to light. There may iris nodules at the pupillary margin, along with corneal endothelial precipitates. The sympathizing eye generally develops photophobia and ocular pain. The posterior segment will have retinal and choroidal swelling, whitish spots indicative of Dalen–Fuchs nodules, and possibly an exudative retinal detachment.

In the BOSU study by Kilmartin and co-workers completed in 1998, 17 cases were reported, with an estimated incidence of 0.03/100 000 for a 59 million UK population.

At present, the UK population is 64 million, and there is a much larger volume of eye surgery being performed. Since 1998, greater numbers of patients are receiving surgical management for trauma as the emergency capacity and size of eye units have increased. However, despite increasing population and increasing surgical volumes, there is a clinical impression that the numbers of patients with SO may not be greatly increased and that the causes of the SO are less likely to be related to retinal surgery.

The 2023 prospective, population-based national surveillance study supported the British and Eire Association of Vitreoretinal Surgeons and the Moorfields Eye Charity Trust aims to provide a contemporary update to the original BOSU study and to update the current epidemiology, management and outcomes of SO in the UK. This would, in turn, facilitate the identification of factors associated with better outcomes and help achieve a national consensus on the optimal management for this condition.

The first reporting emails will arrive at the end of March, response rates for the yellow cards were 70-80%, it would be fantastic if we could match (or even surpass) that figure.