Ocular Manifestations of Biopsy-Proven Pulmonary Sarcoidosis in Korea

Abstract

Purpose To investigate the clinical features and ocular manifestations of biopsy-proven pulmonary sarcoidosis in Korea. Methods 55 patients diagnosed with pulmonary sarcoidosis by bronchoscopic or excisional biopsy were included. By retrospective clinical chart review, we investigated features of uveitis, ocular and systemic treatments, visual acuity, angiotensin-converting enzyme level, chest radiography, and pulmonary function tests. Clinical features were analyzed by presence of uveitis, site of biopsy, and first manifested sign of sarcoidosis. Results The group with uveitis (n = 39) presented with higher systemic (71.8%) and immunosuppressive treatment rates (35.9%) than the group without uveitis (31.3%, 0%, resp.) (P = 0.007, P = 0.005, resp.). There were no significant differences in clinical features, including systemic treatment rate, by type of biopsy. Of 39 patients with uveitis, the group with ocular manifestation as a first sign of sarcoidosis showed higher systemic and immunosuppressive treatment rates (88.9%, 55.6%) compared to the group with pulmonary manifestation as a first sign (57.1%, 19.0%) (P = 0.037, P = 0.018, resp.). Conclusions In patients with biopsy-proven pulmonary sarcoidosis, the presence of ocular involvement and uveitis as a first sign could be significant factors associated with higher systemic treatment rate, especially with immunosuppressive agents. Biopsy site determined by location and size had no influence on clinical features.

Sarcoid Uveitis: An Intriguing Challenger

“…Anterior granulomatous uveitis with anterior or posterior synechiae (20-23%) and keratic precipitates in the lower half of the cornea (if white and not pigmented this represents active inflammation) is the most frequent presentation (60-80%). Nodules on the pupillary margin (Koeppe) or in the stroma (Busacca) are present when uveitis is active, their regression is a sign of therapeutical efficacy [1,3,6,60,123] (Figure 2). Calcific band keratopathy due to subepithelial deposition of calcium, punctate keratitis secondary to keratoconjunctivitis sicca (KCS), interstitial keratitis, and peripheral ulcerative keratitis (PUC) are rarely reported as signs of corneal involvement [1,3,61,123].…”

“…Anterior granulomatous uveitis with anterior or posterior synechiae (20-23%) and keratic precipitates in the lower half of the cornea (if white and not pigmented this represents active inflammation) is the most frequent presentation (60-80%). Nodules on the pupillary margin (Koeppe) or in the stroma (Busacca) are present when uveitis is active, their regression is a sign of therapeutical efficacy [1,3,6,60,123] (Figure 2). Intermediate uveitis presents with floaters and blurry vision, dense vitreous opacities, aggregates of inflammatory cells (snowballs) or accumulation of white fibrous exudates (snowbanks) at the level of pars plana [1,3,41,59].…”

“…With respect to ocular involvement, different percentages are published in the literature, ranging from 12% to 70.9%, and the presenting symptom can be localized in the eye in approximately 30–40% of systemic S [ 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. These observations further support the hypothesis that environmental, occupational, and para-occupational agents play an important role in the development of S ( Table 1 ).…”

“…Several patients are asymptomatic at onset (more than one-third) or may complain of weight loss, fever, fatigue, shortness of breath, cough, chest pain, polyarthritis, erythema nodosum [ 60 ].…”

Noninfectious uveitis in the Asia–Pacific region

“…Genetic factors and pathogenic participation may both play roles. Overall, 30-70% of patients with systemic sarcoidosis may be affected by uveitis during the clinical course [71,72]. Western literature generally shows that 3-10% of uveitis cases are associated with sarcoidosis.…”