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Sarah Sunshine, Dmitry Pyatetsky, Andrea D Birnbaum, Debra A Goldstein; Should patients with sarcoidosis be screened for asymptomatic ocular inflammation?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2172.
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(1) Determine the utility of screening examinations in asymptomatic patients with systemic sarcoidosis (2) Determine the proportion of sarcoidosis patients with conjunctival lesions that could serve as a potential biopsy site.
IRB approval was obtained for this prospective study. Patients with biopsy proven systemic sarcoidosis and no history of uveitis who were referred for ocular screening underwent review of systems, medical history, complete ocular examination. Patients with symptoms consistent with uveitis were excluded. Signs of ocular inflammation including conjunctival granulomas, anterior chamber or vitreous cell, retinal vasculitis, choroiditis, macular edema were recorded.
42 patients were included. 60% were female; mean age was 52.5 years (range 32-69); 24% self-reported as African American, 26% Caucasian, 4.8% Asian; 45% were of unknown race. 40 patients (95%) had no signs of ocular inflammation. Two patients had mild ocular inflammation requiring no additional treatment. One had rare anterior chamber cell and the other a solitary vitreous snowball. 43% were on systemic immunomodulatory therapy (IMT). 54% had conjunctival nodules in the inferior fornix, 33% of patients on IMT had conjunctival nodules and 70.8% of patients not on IMT had conjunctival nodules.
No patient with biopsy proven systemic sarcoidosis in this series had asymptomatic intraocular inflammation requiring therapy. Patients with systemic sarcoidosis should be advised of symptoms of ocular inflammation but, based on this small series, there is no evidence to suggest that they need routine screening for uveitis. Previous data from our group has suggested a diagnostic yield of 63% when conjunctival lesions are biopsied and multi-planar sectioning performed ([i]). More than half the patients in this series had conjunctival nodules, and these were more likely to be seen in patients not on anti-inflammatory therapy. Patients with suspected systemic sarcoidosis and no easily accessible site for biopsy may be referred for ophthalmic examination to look for conjunctival nodules that can be biopsied for pathologic diagnosis.[i] KM Bui, JM Garcia-Gonzalez, SS Patel, AY Lin, DP Edward,DA Goldstein. Directed Conjunctival Biopsy and Impact of Histologic Sectioning Methodology on the Diagnosis of Ocular Sarcoidosis. J Ophthalmic Inflamm Infect. 2014 Mar 18;4(1):8.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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