Journal List > J Korean Ophthalmol Soc > v.49(9) > 1008082

Kim, Chung, and Yu: Clinical Features in Korean Patients with Sarcoid Uveitis

Abstract

Purpose

To investigate the clinical features of Korean patients with sarcoid uveitis.

Methods

The medical records of patients with endogenous uveitis who were recruited from the uveitis clinic at Seoul National University Hospital were reviewed. Sex, age at presentation, ocular symptoms and signs, treatment, complications, and the rate of recurrence were analyzed.

Results

Of 440 patients with endogenous uveitis, 31 (7.1%) with sarcoidosis were included. The mean age at onset was 54.5 years. Sarcoidosis patients with uveitis tended to be older than those without uveitis (44.1 years). Uveitis was the primary manifestation of sarcoidosis in 16 of 31 patients (51.6%). Anterior uveitis was the most common in terms of the anatomic location of inflammation (54.8%), and posterior involvement (38.7%) was not rare. Systemic corticosteroid therapy was administered to 28 patients (90.3%). Five patients (16.1%) received corticosteroids combined with immunosuppressive agents.

Conclusions

Sarcoid uveitis is not a rare etiology of endogenous uveitis. Topical or systemic corticosteroids could control inflammation in most cases, but immunosuppressive agents are needed in a small percentage of patients. Steroids combined with immunosuppressive agents can prevent severe visual losses in such patients.

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Figure 1.
Complications that developed in 31 patients with sarcoid uveitis. Cataract was the most common complication and high intraocular pressure was the second.
jkos-49-1483f1.tif
Figure 2.
Kaplan-Meier type curves for cumulative probability of eyes without recurrence in patients with sarcoid uveitis. A solid line represents estimated risk for recurrence in patients who had uveitis attack first. A dotted line represents that in patients who had extraocular involvement first. There was significant difference between the ocular and extraocular group ( p=0.03, log-rank test) and uveitis-first group had higher possibility of recurrence than extraocular-first group.
jkos-49-1483f2.tif
Table 1.
Comparison of sex ratio and age at presentation between patients with and without sarcoid uveitis during follow-up
With sarcoid uveitis Without sarcoid uveitis P value
Male to Female ratio 6;25 28:58 0.22
Age at presentation 54.5±14.1 44.1±11.0 0.02

Chi-square test

Independent t-test

Table 2.
Duration of follow-up, laterality of involvement, anatomic classification of uveitis, and visual acuity at presentation, routes for histopathological diagnosis in 31 patients with sarcoid uveitis
Duration of follow-up (mo) 28.8±33.7
Bilateral : Unilateral (patients) 27:4
Routes (patients)
Bronchoscopy 12 (44.5%)
Mediastinoscopy 9 (33.3%)
Skin 5 (18.5%)
Lymph node 1 (3.7%)
Anatomic location of uveitis (patients)
Anterior : Intermediate: Posterior: Panuveitis 18:1:4:8
Initial visual acuity (eyes)
20/50- 42 (72.4%)
20/200-20/50 13 (27.4%)
-20/200 3 (5.2%)
Initial work up
Serum ACE (angiotensin converting enzyme) 20/27 patients (74.1%)
Bilateral hilar lymphadenopathy on chest X-ray 19/31 patients (61.3%)
Table 3.
Positive symptoms at presentation in 31 patients with sarcoid uveitis
First presenting symptoms Number of patients (%)
Eye symptoms or signs 16 (51.6%)
Visual acuity decrease 8 (25.8%)
Redness 6 (19.4%)
Floater 2 (6.5%)
Extraocular symptoms 15 (48.4%)
Pulmonary (including abnormal chest X-ray film) 8 (25.8%)
Skin nodules / Erythema nodosum 4 (12.9%)
General weakness/ Fever 2 (6.5%)
Polyuria and polydipsia 1 (3.2%)
Table 4.
Positive ocular signs at presentation in 31 patients with sarcoid uveitis
Ocular signs Number of patients (%)
Posterior synechia 8 (25.8)
Macular edema 6 (19.4)
Cataract 6 (19.4)
Mutton-fat keratic precipitates 6 (19.4)
Periphlebitis 6 (19.4)
Fine keratic precipitate 5 (16.1)
Chorioretinal infiltrates 5 (16.1)
Dry eye 4 (12.9)
Papillitis 4 (12.9)
High intraocular pressure 3 (9.7)
Vitreous opacity 2 (6.5)
Iris nodules 2 (6.5)
Epiretinal membrane 2 (6.5)
Snowball vitreous opacity 2 (6.5)
Choroidal granuloma 1 (3.2)
Snowbank exudate 1 (3.2)
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