First Author: P.Kumar UK
Co Author(s): M. Gkika A. Elsahn
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Sarcoidosis is a chronic systemic autoimmune disease which belongs to a group of systemic granulomatous diseases. It can be confirmed through characteristic systemic and ocular manifestations and histological findings. Purpose of this study is to analyze clinical characteristics and to determine the visual and systemic outcomes of uveitis patients with sarcoidosis.
Uveitis Clinic, University Hospitals of Leicester, UK
Over a two-year period retrospective study of ocular manifestations on a sample of uveitis patients, each followed for at least 3 months and diagnosed with some form of systemic sarcoidosis. All patients underwent complete ophthalmological examination, along with blood tests, chest x-ray and other examinations depending on their symptoms and signs.
A total of 44 patients were included, with age at onset of 17-72 years and a balanced gender ratio (men 52%). Ocular sarcoidosis included mainly anterior, intermediate and posterior uveitis. Other ocular manifestations included eyelid skin lesions, orbital inflammation, conjunctival lesions and neuro-ophthalmologic manifestations. Complications included cataract, glaucoma, cystoid macular edema, epiretinal membrane formation, macular atrophy and choroidal neovascularization. Thirty-seven patients had original systemic sarcoidosis in addition to ocular localisation. The systemic spread in these patients included pulmonary sarcoids, cutaneous sarcoids, arthritis, renal disease and multiple mononeuritis. The most common therapy consisted of topical corticosteroids and/or a combination of systemic corticosteroids and immunosuppressive drugs. There was positive correlation between several optical coherence tomography findings before and after treatment (p<0.001). Complete visual recovery was obtained for about 61% of all patients and about 68% had retrieved best-corrected visual acuity (BCVA) >6/12 in both eyes. A unilateral loss of BCVA of worse than 6/60 was documented in four patients in the isolated sarcoid uveitis group. No patient suffered from bilateral severe visual impairment or blindness. Factors linked to a poor visual prognosis, defined by BCVA ≤6/12 in at least one eye, were chronic macular oedema and persistent ocular inflammation.
In this series of patients with sarcoidosis, with a prolonged follow-up, sarcoid uveitis was suggestive of a favourable systemic and visual outcome. Ocular sarcoidosis seems to be one of the most common site of extrapulmonary sarcoid manifestations, while clinically isolated uveitis that revealed sarcoidosis remained a strictly ocular condition in most cases.