Non-caseating Conjunctival Granulomas in Patients with Multifocal Choroiditis and Panuveitis

ABSTRACT.Purpose: To investigate the prognosis and complications in patients with peripheral multifocal chorioretinitis (PMC). PMC is a posterior or panuveitis characterized by chronic bilateral vitritis and punched-out lesions in the peripheral retina which occurs commonly in elderly white women and is associated with sarcoidosis. Prognosis and complications are largely unknown. Methods: A structured literature search in PubMed, Embase and Cochrane was performed to identify relevant articles. Articles were screened, and the remaining articles were critically appraised based on relevance and validity. Results: The search yielded 267 articles. Eight relevant articles were retrieved. All studies reported on moderate visual impairment. Macular oedema occurred in 60% of the patients with PMC (range, 0-71%), glaucoma in 27% (range, 25-43%) and an epiretinal membrane in 21% (range, 0-28%). In total, 47% had proven or presumed sarcoidosis. Treatment usually comprised topical corticosteroids, periocular steroid injections and systemic corticosteroids regularly in combination with methotrexate. Conclusion: The prognosis of patients with PMC is characterized by a rather poor visual outcome and the relatively high prevalence of complications. PMC is strongly associated with sarcoidosis. Solid proof for the treatment efficacy of PMC is lacking.

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“…1997). All studies noted the predominance of female gender and elderly age (Table 2) (Nolle & Eckardt 1993; Hershey et al. 1994; Lardenoye et al.…”

Section: Resultsmentioning

confidence: 99%

Peripheral multifocal chorioretinitis

Koop

Ossewaarde

Rothová

2012

Acta Ophthalmologica

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“…We also observed a significantly higher female predominance in ocular involvement (M:F=3:19), when compared with previous studies (M:F=1:2-3) (11, 16, 17). Furthermore, all 3 patients with panuveitis and multifocal choroiditis were females older than 55 yr. White females also seem to be a distinct clinical subgroup of patients with ocular sarcoidosis (18-20). In elderly white female patients, panuveitis and multifocal choroiditis was predominantly associated with the occurrence of cystoid macular edema (72%) and visual loss (42%) (12, 19).…”

Section: Discussionmentioning

confidence: 99%

Ocular Sarcoidosis in a Korean Population

Lee

Kim

et al. 2009

J Korean Med Sci

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The aim of current study was to evaluate the incidence and characteristics of ocular sarcoidosis in a Korean population. We conducted a retrospective study of 104 consecutive patients with biopsy-proven sarcoidosis seen at Asan Medical Center in Seoul, Korea, from 1993 to 2007. Medical records, photographs, and fluorescein angiograms were reviewed. Of 104 patients, 22 (21%) had intraocular involvement with female predominance (86%, M:F=3:19). Of the 39 eyes with ocular involvement, 16 (41%) eyes had isolated anterior uveitis, 12 (31%) eyes had intermediate uveitis, 6 eyes (15%) had panuveitis with retinal vasculitis, and 5 (13%) eyes had panuveitis with punched multifocal choroiditis. Mean duration of ophthalmologic follow-up was 62 months. All ocular inflammation was well managed with topical steroid and/or systemic steroid with relatively good final visual outcomes. Ocular complications such as cataract (12 eyes, 30%), glaucoma (6 eyes, 15%), vitreous opacity (1 eye, 3%), cystoid macular edema (3 eyes, 7%), neovascularization (2 eye, 5%), and epiretinal membrane (4 eye, 10%) were related to ocular sarcoidosis. In Korea, where sarcoidosis is very rare, our study indicates relatively low ocular and predominantly non posterior segment involvement with relatively good visual prognosis.

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“…Hershey et al 21 found that four of seven patients with conjunctival granulomas as a component of sarcoidosis had elevated serum angiotensin-convertingenzyme levels. In the patient under discussion, the value had been normal on two occasions before the biopsy.…”

Section: Pathological Discussionmentioning

confidence: 99%

Case 37-1996

Gittinger¹,

Hedley‐Whyte²

1996

N Engl J Med

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A 51-year-old man was admitted to the hospital because of visual "instability" and an intracranial mass.The patient was an accountant. He had been well until six years earlier, when he began to have difficulty fixating on the proper line when reading pages with columns of figures. The problem was bilateral but appeared to be worse in the left eye. Five years before admission, he noticed a progressive loss of vision in the left eye. Two years later, he experienced anosmia and had urinary frequency and urgency, with nocturia five times nightly. Several days before admission to this hospital, the patient entered another hospital, where a cranial magnetic resonance imaging (MRI) scan ( Fig. 1 and 2) showed a densely enhancing extraaxial subfrontal mass, 5.5 cm by 2.2 cm by 1.7 cm on T 2 -weighted images. The mass, which was isointense on T 1 -weighted images and hypointense on T 2 -weighted images, extended along the falx into the interhemispheric fissure, along the inferior surface of the left basal ganglia and hypothalamus, and into the suprasellar region, where it surrounded the left optic chiasm and abutted the left aspect of the pituitary stalk. The frontal lobes were involved, with extensive vasogenic edema in the white matter of the inferior frontal lobes and in the external capsules. The mass encased and narrowed the distal left internal carotid artery, the proximal portions of both anterior cerebral arteries, and the left middle cerebral artery. Scattered, nonspecific hyperintense areas were seen in the periventricular white matter. There was a retention cyst in the right maxillary sinus, with mucosal thickening in the left maxillary and bilateral ethmoid sinuses. The patient was referred to this hospital.He had worked as a paint stripper 15 years earlier, with prolonged exposure to solvents. There was a six-year history of sinusitis with chronic, clear postnasal drip. He had smoked a pipe and cigars in the past but did not smoke cigarettes; he drank small amounts of alcohol. There was no history of diplopia, headache, dizziness, dysarthria, dysphagia, epistaxis, risk factors for human immunodeficiency virus (HIV) infection, foreign travel, intolerance of heat or cold, changes in sexual function, impaired judgment, or altered personality. There was a history of parkinsonism in his father but no family history of other neuromuscular disease or cancer. The temperature was 37.2°C, the pulse was 68, and the respirations were 18. The blood pressure was 150/90 mm Hg.On physical examination, no rash or lymphadenopathy was found. The head was normal, and the neck supple. The lungs, heart, abdomen, and extremities were normal; no evidence of arthritis was found. The rectal examination was normal except for slight prostatic enlargement without nodules.

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Non-caseating Conjunctival Granulomas in Patients with Multifocal Choroiditis and Panuveitis

Cited by 40 publications

References 12 publications

Peripheral multifocal chorioretinitis

Peripheral multifocal chorioretinitis

Ocular Sarcoidosis in a Korean Population

Case 37-1996

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