Ocular sarcoidosis: new diagnostic modalities and treatment

Abstract

Purpose of review: Ocular involvement in sarcoidosis is present in up to 80% of patients and is frequently manifested before diagnosis of the underlying systemic disease. Considering the therapeutic consequences, early diagnosis of the underlying disease is advantageous in patients presenting with ocular inflammation. There are several ocular findings suggestive of underlying sarcoidosis, such as granulomatous keratic precipitates, iris nodules, cells in the vitreous humor known as snowballs and snowbanks, and retinal periphlebitis. High suspicion is crucial for the diagnosis of sarcoidosis. This review on ocular sarcoidosis will mainly focus on new diagnostic and treatment modalities.

Recent findings: Recent studies found possible new diagnostic indicators for the diagnosis of ocular sarcoidosis which include not only serum profiles but also vitreous sample analysis. Ophthalmologic imaging techniques have improved to investigate the ocular structure in detail. Results from recent uveitis clinical trials have included sarcoidosis as an underlying cause and have reported positive results.

Summary: The diagnosis of ocular sarcoidosis can be challenging in some cases. High suspicion is important to diagnose ocular sarcoidosis with various laboratory and ophthalmic tools. There are many possible options for the treatment of ocular sarcoidosis including various biologic agents.

Figure 1. wide field color fundus photo (A) and wide field fundus autofluorescence (B)

Color fundus photo(A) shows multiple yellowish spots (sarcoid spots) whereas autofluorescence (B) shows more mall black (hypofluorescence) spots compared to color fundus photo. This indicates there are more retinal pigmentary change due to outer retinal and choroidal inflammation as seen in color fundus photo and fundus examination.

Figure 2. wide field fundus photo and fluorescein angiography

Figure A indicates the area covering conventional photography. Wide field photo can reveal far peripheral retinal lesion (B, white arrow) and vascular Leakage (C, white arrows) and enables the diagnosis of peripheral chorioretinal lesions and vasculitis. It also determines the extent of affected area.

Figure 3. Wide field fundus autofluorescence of left eye

This patient denied any deterioration of left eye vision, but there was increased hyperfluorescence intensity (B) temporal and inferotemporal to the macular area (white arrows) compared to previous visit(A). This finding can reflect active subclinical inflammation

Figure 4. Optical coherence tomography (OCT) with cystoid macular edema

A. The area indicated by white arrow shows several black cystic spaces (cystoid macular edema). Intraretinal fluid accumulation due to inflammation result in retinal thickening and visual deterioration. B. The cystoid macular edema resolved after the treatment. OCT shows normal concave health macular contour. OCT is useful imaging tool for detection of macular edema and assessing treatment response.