Retinal Pigment Epithelium Tear after Immunosuppressive Treatment for Sarcoidosis-related Choroidal Granuloma

Abstract

Purpose To describe the formation of a retinal pigment epithelial (RPE) tear following immunosuppressive treatment of a large choroidal granuloma in a patient with sarcoidosis-related panuveitis. Case Description A 25 year-old woman presented with bilateral sarcoidosis-related panuveitis and optic disc edema in both eyes with a large choroidal granuloma temporal to the fovea in the left eye. She was started on high-dose oral prednisone therapy with improvement in her panuveitis with reduction in size of the left choroidal granuloma. An RPE tear overlying the flattening choroidal granuloma developed by three weeks of treatment. Conclusions Treatment of choroidal granuloma with rapid reduction in size may result in an RPE tear.

A Case of Large Sarcoid Choroidal Granuloma Treated with Steroid Pulse Therapy

“…With respect to ocular sarcoidosis, a few previous reports described the use of steroid pulse therapy for panuveitis [17] or optic neuropathy [18], yet to the best of our knowledge, there are no previously published reports on choroidal granuloma. However, Knickelbein et al [19] reported a refractory patient with a large choroidal granuloma, panuveitis, and optic disc edema being treated with high-dose intravenous steroid therapy. A choroidal granuloma associated with sarcoidosis often responds well to oral steroid therapy, with the therapy often being started with a dose equivalent to prednisolone 20-80 mg, and then gradually tapered and discontinued in 3-10 months [6,20,21].…”

Choroidal sarcoid granuloma: a case report and review of the literature

“…There was only one pediatric patient among the cases who was 10 years old at the time of diagnosis [21]. Of the 26 cases, 16 reported racial demographics with 38% of patients being African American (6/16) [17,20,23,34,36], 38% Caucasian (6/16) [21,24,28,32,35,36], and 25% Asian (4/16) [26,27,29,33]. Among the 26 patients, 30 total eyes were affected, with 19% of patients having bilateral involvement (5/26) [16,18,25,32], and the majority having unilateral involvement [42% right eye (11/26) [15, 17, 20-22, 24, 26, 31, 34, 36], 38% left eye (10/26) [18, 19, 23, 27-30, 33, 35]].…”

“…The most common visual complaint was a progressive painless blurring of vision (21/26) [15, 17, 18, 20, 21, 23-26, 28, 29, 31-34]. Other presentations included floaters (4/26) [15,18,20], eye pain (2/26) [23,32], headaches (2/26) [17,32], and those that were asymptomatic (5/26) [16,19,22,27,30].…”

“…Five patients had been diagnosed with sarcoidosis before developing choroidal granulomas [17,19,20,27,34], one patient had a history of psoriatic arthritis with sacroiliitis [24], two patients had a prior diagnosis of bilateral granulomatosis panuveitis [23,26], and one patient had been diagnosed with bilateral granulomatous iritis 2.5 years prior to the development of the choroidal granuloma [26,36]. Interferon-alpha (INF-a) use was found in 3 patients (2 female, 1 male) that were undergoing treatment for chronic Hepatitis C [18].…”

“…Of the 26, there were single granulomas in 54% (14/26) [15, 17, 19, 21-24, 27-29, 31, 35, 36] and multiple in 46% (12/26) [16,18,20,25,26,30,[32][33][34]36]. Most lesions were yellow (13/26) [16, 17, 19-21, 23, 25, 26, 32, 35, 36] and located at, or temporal to the macula (9/26) [17,21,23,27,29,31,35,36]. Some lesions were described as elevated (9/26) [15,17,21,23,32,[34][35][36], polypoid (1/26) [22], round (1/26) [27], white (3/26) [18,27,29], and creamy (3/26) [16,30,34].…”