Ocular Sarcoidosis Limited to Retinal Vascular Ischemia and Neovascularization

Abstract

A 59-year-old Caucasian male experienced progressive vision loss secondary to retinal vascular ischemia and neovascularization. At no time did he present with uveitis or vasculitis, and his serology tests were all negative. He was soon after diagnosed with sarcoidosis by hilar lymph node lung biopsy. Our patient demonstrates an atypical presentation of ocular sarcoidosis, manifesting solely as neovascularization and retinal vascular ischemia. Ophthalmologists should consider proliferative sarcoid retinopathy in patients with neovascularization.

Keywords: ocular sarcoidosis; ophthalmology; retina; retinal ischemia; retinal neovascularization; retinopathy; sarcoidosis.

Figure 1. Red-Free Fundus Photography of Both Eyes on Initial Presentation

Venous-venous and arteriovenous collaterals are noted in the temporal macula in the right eye (Figure 1a). Both eyes demonstrate bilateral posterior segment neovascularization, though worse in the left eye (Figure 1b).

Figure 2. Fluorescein Angiography of Both Eyes on Initial Presentation

Fluorescein angiography on presentation confirmed the presence of neovascularization bilaterally with enlarged foveal capillary avascular zones and telengiectatic vessels in both eyes (Figure 2a and Figure 2b). Figure 2a (right eye) was taken in the late phase, and Figure 2b (left eye) was taken in the early venous phase.

Figure 3. Red-Free Fundus Photography of Both Eyes 25 Months after Presentation

Red-free images 25 months after presentation demonstrate worsening posterior segment neovascularization despite panretinal photocoagulation. Mature arteriovenous collaterals are noted traversing large areas of capillary dropout and vascular pruning in the temporal macular in the right eye (Figure 3a). The left eye shows regressed neovascularization, marked attenuation and sclerosis of the retinal arterial vasculature, and venous-venous collaterals (Figure 3b).

Figure 4. Fluorescein Angiography of Both Eyes 25 Months after Presentation

Fluorescein angiography 25 months after presentation confirmed the loss of foveal capillary architecture, greater in the right eye (Figure 4a). Persistent neovascularization is also present in the right eye (Figure 4a). Late capillary leakage from telengiectatic vessels is present in the left eye (Figure 4b).