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Hiroshi Takase, Justine R Smith, Nisha Acharya, Jennifer E Thorne, Peter J McCluskey, Bahram Bodaghi, Moncef Khairallah, Kalpana Babu, Nattaporn Tesavibul, Ilknur Tugal-Tutkun, Joyce H Yamamoto, Narsing A Rao, Manabu Mochizuki; Expert recommendations for management of ocular sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5368.
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To establish expert recommendations for management of ocular sarcoidosis.
A questionnaire survey on management of ocular sarcoidosis was circulated to international uveitis experts and collated electronically. Subsequently, a roundtable discussion was conducted at the Global Ocular Inflammation Workshops (GOIW) in June, 2019 in Sapporo, Japan. By voting on recommendations for the management of ocular sarcoidosis, statements supported by a 2/3 majority were taken as consensus agreement.
A total of 98 participants from 30 countries responded to the questionnaire. A roundtable discussion by 10 international panel members established expert recommendations for management of ocular sarcoidosis as follows:I. Six ocular signs (AC cells, new-onset keratic precipitates, iris nodules, angle nodules, new-onset posterior synechia, raised IOP) in anterior uveitis (AU), four signs (diffuse vitreous opacities, snowball-like vitreous opacities, snowbanks, macular edema) in intermediate uveitis (IU), and five signs (macular edema, optic disc nodules, nodular periphlebitis, active chorioretinal peripheral lesions, choroidal nodules) in posterior uveitis (PU) are the indicators for treatment.II. First-line therapy for severe AU is instillation of corticosteroid eyedrops (prednisolone acetate 1% or similar) at least 10 times per day; for moderate AU frequency is at least 6 times per day. Second-line therapy for AU is regional or systemic corticosteroids.III. First-line therapy for IU is oral corticosteroid, periocular/intravitreal triamcinolone acetonide injection, or intravitreal corticosteroid implant. Second-line therapy is systemic immunosuppressive drugs.IV. First-line therapy for PU is oral corticosteroid, systemic immunosuppressive drug, periocular/intravitreal triamcinolone acetonide injection, or corticosteroid implant. Second-line therapy is systemic immunosuppressive drugs.V. Drugs; mean initial dose of prednisone/prednisolone is 0.5-1.0mg/kg/day, to a maximum dose of 80 mg/day, and mean duration of the initial dose is 2-4 weeks. The average duration of prednisone/prednisolone is 3-6 months. Initial immunosuppressive drugs are methotrexate, cyclosporine, azathioprine or mycophenolate mofetil. In selected settings intravenous pulse corticosteroid may be considered. Biologic drugs are used if necessary.
Expert recommendations for management of ocular sarcoidosis were established in a consensus workshop.
This is a 2020 ARVO Annual Meeting abstract.
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