Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis that can present after trauma or intraocular surgery (IOS). The incidence of SO following IOS varies between studies. The purpose of our study was to determine the incidence proportion of SO following IOS.
The incidence proportion of SO following IOS can provide physicians consenting patients for surgery with information on the risk of SO.
Systematic review and meta-analysis. MEDLINE, EMBASE, and Cochrane databases were searched from inception to January 2023 for population-based studies on SO following IOS. Two reviewers independently screened the results. Random-effects meta-analyses calculated incidence proportion. Subgroup analysis assessed SO incidence based on IOS type and technological advancements. Study quality and bias were assessed using the Newcastle-Ottawa Scale and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.
The final meta-analyses included 19 studies, with 118 cases of SO following 505,178 inciting events. The estimated overall incidence proportion of SO after IOS was 0.061% (95% CI 0.033 % – 0.111%, I = 83%) and the estimated incidence rate was 9.24 cases per 100,000 person-years (95% CI 4.03 – 21.19, I = 88%). The average study duration across these studies was 10.8 years. Within the reviewed literature, SO following glaucoma and vitreoretinal IOS was most studied, with 9 and 6 studies, respectively. Observed differences in incidence between glaucoma (0.098%, 95% CI 0.042% – 0.232%, I = 40%) and vitreoretinal IOS (0.043%, 95% CI 0.022% – 0.085%, I = 88%) were not statistically significant (p = 0.14). There was also no significant difference in the incidence proportion before and after the year 1975 (0.060% vs. 0.058%, p = 0.98). The outcome measures showed low-certainty GRADE evidence.
SO after IOS is rare and might not have changed over the past five decades. The estimated incidence proportion of sympathetic ophthalmia may be useful in consenting patients before IOS. There may be also no significant difference in the incidence of SO between glaucoma and vitreoretinal surgeries, based on low certainty evidence.

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