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PS Tsai, ET Cunningham; Prevalence of Elevated Serum Angiotensin Converting Enzyme and Lysozyme Levels in Sarcoid Uveitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4255.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To determine the sensitivity and specificity of elevated serum angiotensin converting enzyme and elevated serum lysozyme levels in patients with presumed and biopsy-proven ocular sarcoidosis seen at a university referral center. Methods:We reviewed the records of 2,185 consecutive patients with active uveitis that were seen at the Francis I. Proctor Foundation from January 1977 to December 1996. 90 patients with presumed ocular sarcoidosis and 7 patients with biopsy-proven ocular sarcoidosis were identified. Information regarding demographics, diagnostic, and clinical characteristics were collected. Results:The prevalence of presumed and biopsy-proven ocular sarcoidosis among all consecutive uveitis patients was 4.1% and 0.3%, respectively. Patients with presumed ocular sarcoidosis were more likely to be female(63.3%) and more likely to have bilateral(82.2%), diffuse(47.8%) uveitis compared to the overall uveitis population. The serum angiotensin converting enzyme level was elevated in 36 out of 83 (43.4%) tested cases and serum lysozyme level was elevated in 58 out of 72 (80.6%) of tested cases. Patients with biopsy-proven sarcoidosis were more likely to be black(57.1%) and more likely to have a bilateral(85.7%), diffuse(42.9%) uveitis compared to the overall uveitis population. The serum angiotensin converting enzyme level was elevated in 3 out of 4 cases (75%)and the serum lysozyme level was elevated in 4 out of 4 (100%) tested cases. Of the 2,185 patients seen at the Uveitis Clinic, 96 patients had an elevated serum angiotensin converting enzyme level and 205 patients had an elevated lysozyme level. Of the 96 patients with elevated serum angiotensin converting enzyme, 3(3.1%) had biopsy-proven and 36(37.5%) had presumed ocular sarcoidosis. Of the 205 patients with elevated serum lysozyme, 4(2%) had biopsy-proven and 58(28.3%) had presumed ocular sarcoidosis. Conclusion:Sarcoidosis is a common cause of uveitis at tertiary referral centers, tends to be more common in women, and is often diffuse and bilateral. Directed laboratory testing allows for the identification of a number of presumed cases of ocular sarcoidosis, but is imperfect with limited sensitivity and specificity.
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