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B. Burton, D. Kidd, E. Graham, G. Plant; Optic Neuropathy in Proven and Presumed Sarcoidosis: Clinical Features and Response to Treatment in 24 Cases . Invest. Ophthalmol. Vis. Sci. 2003;44(13):637.
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Purpose: To report the clinical, laboratory, imaging findings and response to treatment of 24 cases of sarcoidosis affecting the optic nerve. Methods: A case note review of 24 patients, mean age 41 (20 to 71), of whom 12 were female and 12 were Afro-Caribbean, the remainder were Caucasian. Results: Eight patients had prior evidence of sarcoidosis before presentation. Loss of vision occurred over a period of just a few days in most cases accompanied by, or preceded by pain in 72% of cases. Twelve were bilateral. Two cases improved spontaneously without steroid treatment. Twenty-two cases were treated with high dose steroids, nine of whom showed a worsening of acuity upon stopping or reducing the steroid dose. Nine patients were treated additionally with azathioprine and two with Methotrexate. 21 out of 36 affected eyes developed visual acuity at worst of 6/60 or poorer. Visual outcome was good in all eleven patients given steroids within one week of visual loss and a delay in treatment beyond four weeks was associated with a poor response to treatment in four out of seven cases. Mean follow up was seventeen months; 7 out of 36 eyes followed had a final acuity of worse than 6/12. Conclusions: Patients require close observation and high dose steroids which should be reduced very slowly over several months. Many patients require steroid treatment for more than a year. A more rapid withdrawal is associated with a significant risk of relapse, and in such cases an immunosuppressive agent may be indicated.
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