Clinical Manifestations, Complications and Treatment of Ocular Sarcoidosis: Correlation between Visual Efficiency and Macular Edema as Seen on Optical Coherence Tomography

Abstract

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. Biopsy is the golden standard for diagnosing sarcoidosis. Ocular sarcoidosis can be confirmed, probable, or possible. Over a two-year period, ocular manifestations were studied on a sample of 52 patients, each followed for four months and diagnosed with some form of systemic sarcoidosis. Most frequent systemic manifestations in patients with ocular sarcoidosis were pulmonary, skin, glandular, and systemic generalized sarcoidosis. The disease was diagnosed four times more frequently in females than males (42:10, respectively; p < 0.05). Most frequent, and statistically significant, manifestation of ocular sarcoidosis is anterior uveitis (64.61%; p < 0.01). Macular edema and periphlebitis associated with periarteritis were frequent, and statistically significant (43.90% and 29.26%, respectively; p < 0.05). Overall, with regards to gender and location (right eye; left eye), visual acuity was >0.5 and of statistical significance (76.92%; p < 0.01). The most common therapy consisted of systemic corticosteroids (26.67%) and/or a combination of corticosteroids and immunosuppressive drugs (23.33%). In 16 eyes treated with repeated doses of sub-Tenon's injections, both initial and control visual acuity correlated with average thickness. There was positive correlation between several optical coherence tomography findings before and after treatment.

Ocular Sarcoidosis

“…33,66,67 However, 2.4 to 10% of patients with sarcoid uveitis develop severe visual impairment (defined as best-corrected visual acuity <20/200 in at least one eye). 3,33,34,68 The main cause of visual loss is cystoid macular edema. 33,69,70 A poor visual prognosis has been associated with advanced age, black phototype, female gender, underlying chronic systemic disease, ocular posterior segment involvement, multifocal choroiditis, presence of cystoid macular edema, persistent ocular inflammation, and glaucoma.…”

Immune Complex-positive Glomerulonephritis in Antineutrophil Cytoplasmic Antibody-positive Patients

“…57,58,63 Cystoid macular edema is also a common complication of this condition that can lead to severe visual loss. 113…”

Microangiopathy in Ocular Sarcoidosis Using Fluorescein Gonio and Fundus Angiography from Diagnostic and Therapeutic Aspects

“…The reported complications of ocular sarcoidosis include cataract, macular edema (ME), glaucoma, vitreous hemorrhage, retinal ischemia, retinal detachment, subretinal neovascularization (NV), and optic nerve disease [1][2][3][4][5]. Of those, glaucoma, cystoid ME, and retinal detachment are the most serious, as they can lead to blindness.…”