June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Expert recommendations for management of ocular sarcoidosis
Author Affiliations & Notes
  • Hiroshi Takase
    Tokyo Med and Dent Univ, Meguro-ku, TOKYO, Japan
  • Justine R Smith
    Flinders University College of Medicine & Public Health, South Australia, Australia
  • Nisha Acharya
    Proctor Foundation, University of California San Francisco, California, United States
  • Jennifer E Thorne
    The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Maryland, United States
  • Peter J McCluskey
    Save Sight Institute, Discipline of Ophthalmology Sydney Medical School, New South Wales, Australia
  • Bahram Bodaghi
    Sorbonne Université, France
  • Moncef Khairallah
    University of Monastir, Tunisia
  • Kalpana Babu
    Prabha Eye Clinic & Research Centre, India
  • Nattaporn Tesavibul
    Mahidol University, Thailand
  • Ilknur Tugal-Tutkun
    Istanbul University, Turkey
  • Joyce H Yamamoto
    Universidade de Sao Paulo, Brazil
  • Narsing A Rao
    Keck School of Medicine of University of Southern California, California, United States
  • Manabu Mochizuki
    Tokyo Med and Dent Univ, Meguro-ku, TOKYO, Japan
    Miyata Eye Hospital, Japan
  • Footnotes
    Commercial Relationships   Hiroshi Takase, None; Justine Smith, None; Nisha Acharya, None; Jennifer Thorne, None; Peter McCluskey, None; Bahram Bodaghi, None; Moncef Khairallah, None; Kalpana Babu, None; Nattaporn Tesavibul, None; Ilknur Tugal-Tutkun, None; Joyce Yamamoto, None; Narsing Rao, None; Manabu Mochizuki, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5368. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To establish expert recommendations for management of ocular sarcoidosis.

Methods : 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.

Results : 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 eye
drops (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.

Conclusions : 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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