Purpose:
To analyze a series of sarcoid uveitis patients in order to further characterize this condition, including: epidemiology, anatomy, clinical findings, diagnostic methods, course of disease, treatment, and complications to add to the body of knowledge and define the disease in this urban Midwest region.
Methods:
A retrospective chart-review was conducted on patients seen at Kresge Eye Institute with the International Diagnostic Code 3643 (iritis/uveitis). Those whose initial exam suspected sarcoid uveitis were entered in a database. A systematic chart review for a subsequent workup that demonstrated biopsy proven or presumed sarcoid was done with data collected on various epidemiologic parameters. Presumed sarcoidosis was defined as the triad of clinical suspicion, supporting lab data, and consistent radiographic findings.
Results:
Eighty-three patients were entered, mean age was 41.4 years and mean follow-up was 4.8 years. Of them, 90.4% were African-American and 74.7% were female. African-American males presented at a statistically significant earlier age than African-American females (42.7 and 33.4 years respectively, p=0.0062). Bilateral ocular involvement occurred in 90.4% (75/83). The most common type of uveitis in our cohort was panuveitis, 69.9% (58/83), while 24.1% had anterior involvement only. Visual acuity for all 156 eyes did not significantly change from presentation to final visit (LogMAR 0.42 to 0.46, p=0.10). However if the panuveitis group is evaluated separately, vision decreased (LogMAR 0.48 to 0.6, p=0.018). All patients received topical steroids; 24.1% fared well with topical alone, 16.9% received posterior sub-Tenon Kenalog, 2.4% were treated with I.V. Kenalog, 49.4% required systemic steroids, 18.1% needed immunomodulation, however most required a combination of modalities. Of all patients, 39.8% had a chronic unremitting course, 37.7% had recurrent bouts, and 22.9% had a monophasic course. Of the seventeen complications observed, the three most common were cataract, glaucoma and epiretinal membrane.
Conclusions:
In this urban tertiary care center population, panuveitis, not anterior uveitis, was most commonly seen. Furthermore, African-American men presented at a significantly earlier age than African-American women with sarcoid uveitis. Further analysis of subgroups needs to be carried out to elaborate true differences, prognostic factors, risk factors, and treatment outcomes.