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W.W. Li, N.K. Wade; Factors Influencing the Presentation, Course, and Outcome of Uveitis Secondary to Ocular Sarcoidosis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2420.
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To identify clinical findings and demographic variables that could influence the presentation and predict the course or outcome of uveitis secondary to ocular sarcoidosis.
562 consecutive uveitis patients with possible ocular sarcoidosis seen by a single uveitis subspecialty ophthalmologist were identified from a retrospective chart review. Included in this study were 276 of these patients with either biopsy–proven or clinically presumed ocular sarcoidosis based on predetermined criteria. 198 patients with suspected ocular sarcoidosis were excluded because they did not meet our rigid criteria requiring 5 of 10 clinical signs along with both imaging and laboratory support for the diagnosis. 88 patients ultimately had a confirmed alternate diagnosis and were excluded. Demographics, clinical findings, disease course, complications, treatment, and outcomes were recorded, analyzed, and compared.
Mean age was 43 (range 5–89), with the majority of patients being Caucasian (72%) and female (62%). Mean follow–up was 4.5 years. 17% of patients had a diagnosis of systemic sarcoidosis prior to ocular disease. The most common presentation was an insidious onset (86%), bilateral (91%), diffuse uveitis (78%). The most frequent clinical signs were granulomatous keratic precipitates (57%), choroidal granulomas or choroiditis (51%), and snowballs (49%). The most frequent complications were cataract (67%) and glaucoma (46%). Diffuse uveitis generally had the longest time to quiescence (mean 45 months), worst signs, and worst prognosis as compared to all others. Those patients also had the most complications, with the exception of glaucoma, which was more prevalent in anterior uveitis. Asians were more likely to develop cataract (83%) and glaucoma (67%) complications as compared to all others (65% P<0.007 & 44% P<0.004 respectively). In contrast, East Indians had the longest mean time to quiescence (64 months) and were more likely to take on a chronically active disease course (92%) as compared to all others (31 months P<0.003; 80% P<0.04). Caucasians were more likely to present with multifocal choroidal "punched out" lesions (50%) as compared to all others (11% P<0.007). Males were found more likely to develop glaucoma (65%) and hypertensive uveitis (35%) as compared to females (35% & 19% respectively; P<0.005 each)
This is the largest sarcoidosis uveitis series of which we are aware, and is the only study to address variations based on Asian and East Indian ethnicities. This study identifies factors which influence presentation, course, and outcome of uveitis secondary to ocular sarcoidosis.
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