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Xia Ni Wu, Rachael Niederer, Lazha Sharief, Susan Lightman, Oren Tomkins-Netzer; Cross-sectional study of sarcoid uveitis diagnostic criteria, disease control and long-term visual outcome. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4193.
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Ocular sarcoidosis can be challenging to diagnose without invasive tests. We evaluated the International Workshop on Ocular Sarcoidosis (IWOS) diagnostic criteria in a large clinic cohort and further examined disease control and long-term visual function.
IWOS clinical and laboratory diagnostic criteria were applied to subjects with sarcoid uveitis and systemic disease confirmed by a physician. The comparison group were subjects with noninfectious uveitis.
287 eyes (151 subjects, 66.2% female) with sarcoid uveitis were identified from the database population of 1254 (12.0%). Average age at presentation was 43.1±0.8 years and mean follow up was 11.4±0.5 years. Sarcoidosis diagnosis was definite (biopsy proven) in 92 subjects (60.9%), presumed in 29 (19.2%), probable in 4 (2.6%), and possible in 2 (1.3%). The most common signs were bilaterality (90.1%), vitreous snowballs or string of pearls (52.3%), chorioretinal peripheral lesions (51.0%), anterior segment granulomatous disease (44.4%), and angle abnormalities (54.5% of 77 subjects). Mean number of clinical signs was 3.1±0.1. Serum ACE levels were elevated in 82.9%. Chest x-ray was positive in 96 (80.0%) and chest computed tomography was positive in 41 (93.2%). 150 subjects (99.3%) had a negative quantiFERON-TB gold test. Sarcoid uveitis had better visual outcomes than other noninfectious uveitis (anterior uveitis p=0.002, posterior uveitis p=0.001). Median visual acuity was logMAR 0.00 at 10 years. Periphlebitis, granulomas and nodules, and bilaterality were associated with vision loss (p=0.005, p=0.036, p=0.002 respectively). Oral corticosteroid use was more common in sarcoid anterior uveitis (p<0.0005). Second-line immunosuppression was required less frequently in sarcoid posterior uveitis (p=0.008).
The most common clinical features from the IWOS criteria at presentation were bilaterality, positive serum ACE, and chest imaging abnormalities. While many subjects presented with some of the IWOS diagnostic criteria, many of these signs are nonspecific such as bilaterality and vitreous snowballs, and subjects may have no or few clinical signs. Vision loss was uncommon and associated with periphlebitis, granulomas and nodules, and bilaterality. Compared to other noninfectious uveitis, sarcoid uveitis has better visual acuity outcomes and is less likely to require second-line immunosuppression.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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