Diagnostic Markers in Ocular Sarcoidosis in A High TB Endemic Population – A Multicentre Study

Babu, Kalpana; Biswas, Jyotirmay; Agarwal, Manisha; Mahendradas, Padmamalini; Bansal, Reema; Rathinam, Sivakumar R.; Basu, Soumyava; Ganesh, Sudha K; Konana, Vinaya Kumar; Vedhanayaki, Rajesh; Philips, Mariamma; Choudhary, Tripti

doi:10.1080/09273948.2020.1778733

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…Furthermore, granulomatous uveitis are also associated with tuberculosis, syphilis, multiple sclerosis, Vogt-Koyanagi-Harada syndrome, toxoplasmosis and herpetic uveitis [76]. Choroidal granulomas are often seen in tuberculosis, making this infectious disease a challenging differential diagnosis [77,78]. No "simple" marker is available to make the diagnosis of sarcoidosis and therefore systemic investigations are required.…”

Section: Sarcoidosis: a Challenging Diagnosismentioning

confidence: 99%

Sarcoidosis-Related Uveitis: A Review

Giorgiutti

Jacquot

Jammal

et al. 2023

JCM

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Sarcoidosis is an inflammatory disease that involves the eyes in 10–55% of cases, sometimes without systemic involvement. All eye structures can be affected, but uveitis is the most common ocular manifestation and causes vision loss. The typical ophthalmological appearance of these uveitis is granulomatous (in cases with anterior involvement), which are usually bilateral and with synechiae. Posterior involvement includes vitritis, vasculitis and choroidal lesions. Tuberculosis is a classic differential diagnosis to be wary of, especially in people who have spent time in endemic areas. The diagnosis is based on histology with the presence of non-caseating epithelioid granulomas. However, due to the technical difficulty and yield of biopsies, the diagnosis of ocular sarcoidosis is often based on clinico-radiological features. The international criteria for the diagnosis of ocular sarcoidosis have recently been revised. Corticosteroids remain the first-line treatment for sarcoidosis, but up to 30% of patients require high doses, justifying the use of corticosteroid-sparing treatments. In these cases, immunosuppressive treatments such as methotrexate may be introduced. More recent biotherapies such as anti-TNF are also very effective (as they are in other non-infectious uveitis etiologies).

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Section: Sarcoidosis: a Challenging Diagnosismentioning

confidence: 99%

Sarcoidosis-Related Uveitis: A Review

Giorgiutti

Jacquot

Jammal

et al. 2023

JCM

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“…In a review of patients with biopsy-proven granulomatous uveitis as either ocular sarcoidosis or tuberculosis (with a response to anti-tubercular therapy), a low score on a Schirmers test, the presence of bilateral disease, depigmented chorioretinal scars, candle wax retinal vasculitis, a negative QuantiFERON Gold or Mantoux test, the presence of bilateral hilar lymphadenopathy or fissural nodules were all more consistent with a diagnosis of ocular sarcoidosis than of tuberculosis. [ 49 ] In a similar study from the same group, in patients with biopsy-proven granulomatous uveitis and a Schirmer test ≥10 mm, a positive Mantoux test, and pigmented multifocal choroiditis along retinal blood vessels, the likelihood ratio of uveitis being secondary to tuberculosis was reported to be approximately 77%. [ 50 ]…”

Section: Sarcoidosis In Tb-endemic Regionsmentioning

confidence: 99%

“…Sarcoidosis should be considered in patients who have uveitis, anterior or otherwise, alongside dry eye disease as evidenced by decreased Schirmers testing. [ 49 ] It should be considered in patients who have bilateral intermediate or posterior uveitis with candlewax phlebitis, the presence of snowballs, or a string of pearls appearance of vitreous condensation. [ 9 10 49 ] In those with anterior uveitis, bilateral disease, the presence of mutton fat keratic precipitates, iris nodules, or broad-based peripheral anterior synechiae should be considered suspicious for sarcoidosis.…”

Section: Current Recommended Approaches To the Diagnosis Of Ocular Sa...mentioning

confidence: 99%

“…[ 49 ] It should be considered in patients who have bilateral intermediate or posterior uveitis with candlewax phlebitis, the presence of snowballs, or a string of pearls appearance of vitreous condensation. [ 9 10 49 ] In those with anterior uveitis, bilateral disease, the presence of mutton fat keratic precipitates, iris nodules, or broad-based peripheral anterior synechiae should be considered suspicious for sarcoidosis. [ 9 10 ] Posterior findings such as bilateral peripheral hypopigmented chorioretinal lesions, granulomas, or scattered hypocyanescent lesions on indocyanine green angiography (ICG) are also consistent with sarcoidosis.…”

Section: Current Recommended Approaches To the Diagnosis Of Ocular Sa...mentioning

confidence: 99%

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Progress in the diagnosis of ocular sarcoidosis

O’Keefe¹,

Rao

2022

Indian Journal of Ophthalmology

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Sarcoidosis is a multisystem granulomatous inflammation that affects multiple organ systems. The spectrum of extraocular and ocular involvement is wide and may precede systemic involvement. The diagnosis of ocular sarcoidosis relies on a combination of clinical findings, laboratory investigations, and radiographic findings. These include but are not limited to serum angiotensin-converting enzyme (ACE), lysozyme, plain-film radiographs of the chest, computed tomography (CT) scans of the chest, pulmonary function testing, bronchoalveolar lavage, and retinal imaging among others. In this review, we highlight current and evolving systemic investigations and approaches to ophthalmic imaging when considering the diagnosis of ocular sarcoidosis.

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“…Ocular involvement occurs in 30-60% of subjects, with dry eye and uveitis being the most frequent presentation. [ 3 ] Sarcoid uveitis has protean manifestations. It can present as non-granulomatous and granulomatous anterior uveitis, intermediate uveitis, posterior and panuveitis and retinal vasculitis, among which panuveitis is the most predominant uveitis.…”

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confidence: 99%