Findings and Graduation of Sarcoidosis-Related Uveitis: A Single-Center Study

Ocular involvement is present in up to 79% of sarcoid patients. Uveitis is the main ocular manifestation and presents as a chronic intraocular inflammatory condition with potentially detrimental effects on visual acuity and quality of life. This retrospective study was conducted to explore the incidence and characteristics of ocular sarcoidosis in a single tertiary ophthalmology center. Medical records of 84 patients presenting between June 2007 and March 2021 were analyzed. Based on the “International Workshop on Ocular Sarcoidosis” (IWOS) criteria, ocular sarcoidosis was determined as: definite (n = 24; 28.6%), presumed (n = 33; 39.3%), probable (n = 10; 11.9%), and indefinite (n = 17; 20.2%) in our study population. In 43.9% of the definite and presumed cases, the eye was primarily affected. In addition to specific ocular findings, the diagnosis was supported by biopsy (28.6%) and chest x-ray or computer tomography (66.7%). Moreover, an increased soluble interleukin-2 receptor (sIL-2R) expression (76.2%), elevated angiotensin-converting enzyme (ACE) levels (34.8%), and lymphocytopenia (35.1%) were valuable laboratory findings. Co-affected organs were lungs (60.7%), skin (15.5%), and central nervous system (8.3%). Our findings support the prominent role of the eye in the early detection of sarcoidosis. In addition to the IWOS criteria, sIL-2R, in particular, was shown to be relevant in establishing the diagnosis.

An Interesting Case of Bilateral Hilar Lymphadenopathy Presented with Visual Impairment

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It primarily affects the lungs and lymphatics; however, the presentation is not always pulmonary. Uveitis is the presenting symptom in 5% of patients, predominantly in females. Cystoid macular edema is the most important sight-threatening sequela of ocular sarcoidosis. Histopathological evidence of noncaseating epithelioid granulomas from a biopsy is the gold standard for the diagnosis of ocular sarcoidosis. Diagnosis of sarcoidosis is made by exclusion of other causes of granulomatous disease, mainly tuberculosis and fungal infection and documentation of involvement of at least one additional organ system. The authors present a case of a patient with sarcoidosis involving lungs and eyes, who had uveitis as an initial presentation.

Clinical Usefulness of the Revised International Workshop for Ocular Sarcoidosis Criteria in Korean Patients

Purpose: To compare differences between the original criteria for diagnosis of ocular sarcoidosis (OS) (first International Workshop for OS [IWOS] 2009) and the revised criteria (sixth IWOS 2017), and their clinical usefulness when assessing OS in Korean patients. Methods: We analyzed patients with suspected OS who visited our tertiary referral ophthalmological and pulmonary clinic from 2007 to 2018. We diagnosed patients using both sets of criteria. Blood test and biopsy data (collected by physicians) and slit-lamp, fundus, and fluorescein angiography data (collected by ophthalmologists) were reviewed. Results: Thirty-four patients were diagnosed using both criteria. Of 32 patients who underwent biopsies, 31 had OS (96.87%). Using either set of criteria, 31 patients were diagnosed with definite OS and two with presumed OS. One patient diagnosed with possible OS using the previous criteria was diagnosed with presumed OS using the revised criteria. The new criteria add the lysozyme level, the CD4/CD8 ratio, and positron emission tomography imaging data to the old criteria and add the descriptors “presumed OS” and “probable OS”. There is no need to use the revised criteria in Korea; the biopsy and imaging data are adequately diagnostic. Conclusions: IWOS revised the OS diagnostic criteria by adding new parameters. However, this was unnecessary for Korea, where the biopsy and imaging data are adequately diagnostic.

Ocular sarcoidosis: a case report

Introduction: Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. It is usually idiopathic. Ocular involvement is noted in 25%–60% of patients with systemic sarcoidosis. It is very essential to rule out ocular tuberculosis as both can have similar presentations. Case report: A 26 year old patient presented with blurring of vision in left eye for nine months at Mongar regional referral hospital. Previously he was treated with topical steroids and cycloplegics for anterior uveitis. There were no systemic symptoms like dry cough, fever, chest pain and loss of weight. He had anterior chamber inflammation with iris nodule, vitritis and disc edema in left eye.The right eye had minimal anterior chamber reaction with only subtle iris nodule. Posterior segment examination was normal in right eye. He underwent blood investigations, chest X ray and contrast enhanced computed tomography of chest(CECT). The blood reports were normal. The chest X ray showed radiopaque lesions at both hilar region and multiple tiny radiopaque lesions in both lung fields.CECT chest showed significant paratracheal lymph nodes.Lymph node biopsy was not attempted due to extreme location. Based on clinical presentations and investigation findings a diagnosis of Presumed ocular sarcoidosis was made by using the criteria based on Revised International Workshop on Ocular Sarcoidosis.The patient was treated effectively with oral steroids for six months. Currently he is on low maintenance dose of oral steroids. Conclusions: Ocular sarcoidosis is a potentially blinding condition if not treated on time. There should be high suspicion of ocular sarcoidosis if patient presents with bilateral granulomatous anterior uveitis with hilar lymphadenopathy.However it is crucial to exclude ocular tuberculosis as both are mimickers of chronic granulomatous uveitis.

Chorioretinal Biopsy-Proven Ocular Sarcoidosis in a Patient with a History of B-Cell Lymphoma

The purpose of this report is to describe biopsy-proven ocular sarcoidosis (OS) in a 67-year-old patient with a history of sarcoidosis and diffuse large B-cell lymphoma (DLBCL). Nonspecific posterior chorioretinal lesions in a patient with prior malignancy necessitated chorioretinal biopsy to rule out metastatic lymphoma. The association between sarcoidosis and malignancy remains unclear and can complicate management of similar patients with nonspecific posterior segment findings. Chorioretinal biopsy may, therefore, be required to rule out malignancy in patients with a leading history.