First Author: R.Gonçalves PORTUGAL
Co Author(s): P. Rodrigues C. Menezes J. Lemos P. Coelho B. Vieira J. Serino 0 0 0 0 0 0 0 0 0
Back to previous
To report a case of bilateral uveitis in the context of sarcoidosis and to describe the factors associated with a worse visual prognosis.
Department of Ophthalmology - Hospital Pedro Hispano, Matosinhos, Portugal.
Clinical case report.
A 72 year-old woman was referred to our Ophthalmology Department with complaints of gradual vision loss for the past 2 years. Her best corrected visual acuity (BCVA) was 20/100 OD and 20/400 OS. Anterior segment examination revealed mutton-fat keratic precipitates, anterior chamber cells and posterior synechiae, bilaterally. Fundus was impossible to evaluate for poor dilatation and the presence of opacity in the ocular media due to cataracts. At this point topical therapy with corticosteroids and mydriatics was started. The patient had no systemic complaints and laboratorial investigation was unremarkable, including a normal ACE serum level and a negative tuberculin skin test. Chest X-ray showed bilateral hilar prominence of bronchovascular nature. Before the impossibility of performing fluorescein angiography (FA) that helps setting the diagnosis, she was submitted to bilateral cataract extraction with intraocular lens implantation and posterior synechiolysis. Postoperatively there was little improvement of vision and her BCVA was 20/70 OD and 20/70 OS. A subsequent fundoscopy and FA examination revealed vasculitis, small yellowish peripheral choroidal nodules and cystoid macular edema. It was requested chest computed tomography that showed bilateral hilar lymphadenopathy and along with fundus picture clinched the diagnosis of sarcoidosis. Systemic treatment with immunosuppressive agents was then instituted.
Sarcoidosis is one of the most common systemic disease associations with uveitis in Europe accounting for 3–7% of non-infectious uveitis cases. Uveitis may be the presenting manifestation of sarcoidosis, and ophthalmologists have a critical role in establishing the diagnosis of this disease. Presentation is often insidious and many patients are asymptomatic until the development of complications. So, without acute symptoms, the detection and diagnosis may be delayed, leading to visual deterioration. There are multiple reasons for visual loss in patients with uveitis. Complications such as cataract, glaucoma, optic nerve disease, macular oedema, retinal ischaemia, vitreous haemorrhage, subretinal neovascularization and retinal detachment can all cause visual loss. Like in the presented case, the visual prognosis in ocular sarcoid uveitis is selectively reduced in patients with multifocal choroiditis and in those with retinal vasculitis. Also patients who presented at a greater age, are more often observed to have a chronic than an acute monophasic disease and a resultant worse visual acuity outcome.