First Author: M.Cuesta Lasso SPAIN
Co Author(s): A. Mateos Hernandez L. Monje Fernandez I. Garzo Garcia F. Costales Mier C. Plaza Laguardia M. Cordero-Coma
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Sarcoidosis is an inflammatory disease mediated by T lymphocytes with a wide range of clinical manifestations that can affect all ocular structures.
A 64 years old woman with right eye amblyopia complained of 6 months decreased visual acuity, hands movement right and 20/63 left eye. Great vitritis, yellowish dotted lesions on the middle periphery and cystic macular edema, 611 and 663 micras respectively, without vasculitis in the flourescein angiography was found.
The systemic study revealed multiple bronquial and mediastinal adenopathies.The patient was diagnosed of sarcoidosis by lung biopsy assisted by endobronquial ultrasonography. Corticoid and methotrexate treatment was initiated and a few months later adalimumab was added. She also started tuberculosis quimioprophylaxis as the mantoux test was positive. Three ranibizumab intravitreal injections were applied in her right eye as well as her left eye recieved 3 ranibizumab and 1 aflibercept injections. A decreased macular central thickness was shown but an epirretinal membrane (MER) and vitreomacular traction was developed in her right eye.
In order to improve her vision phacoemulsification followed by a 23 G vitrecthomy and MER peeling was performed as shown in the video. Her final visual acuity improved from hand movements to 20/63 in her right and 20/80 to 20/50 in her left eye.
Up to 20-30% of the cases, sarcoidosis presents with ocular clinic. Although the most frequent manifestations affect anterior structures, we should not lose sight of certain signs such as vasculitis or retinal neovascularization, multifocal choroiditis or the presence of retinal granulomas. Any of them should guide us to include the entity in the differential diagnosis and to complete the systemic study. It will allow an appropriate systemic treatment but sometimes patients need surgery because of the sequelae of inflammation.