Treatment of ocular sarcoidosis. Study of 65 patients from a series of 342 from a university hospital in northern Spain

Abstract

Background and objectives: Ocular involvement in sarcoidosis is a relatively frequent manifestation causing potentially severe complications. Our aim was to evaluate visual outcomes and treatment in a cohort of patients diagnosed with ocular sarcoidosis.

Methods: We conducted a retrospective study of a cohort of 342 patients diagnosed with sarcoidosis according the ATS criteria (compatible clinical, radiological and pathological presentation excluding other granulomatous diseases) from January 1999 to December 2019 in a single university hospital. Ocular manifestations and systemic treatments were assessed: systemic glucocorticoids (GC), conventional synthetic immunosuppressive (csIS) drugs and biological therapy (BT). Best corrected visual acuity (BCVA) according to the different systemic treatments used was compared at diagnosis and after one-year follow-up.

Results: Ocular sarcoidosis was observed in 65 of 342 (19%). Main ocular manifestations were uveitis (54; 83.1%), orbital lesions (5; 7.7%), retinal vasculitis (4; 6.2%), dry eye (4; 6.2%) and scleritis (1; 1.5%). Systemic treatment with GC was used in 52 (80%) patients, csIS in 32 (49.2%) and BT in 17 (26.2%) patients. BT was most used in panuveitis (62.5%), posterior uveitis (60%), intermediate uveitis (50%) and retinal vasculitis (50%). Median BCVA at diagnosis was 0.6 [IQR: 0.3-0.8] and 0.9 [0.6-1] at one year later, no significant differences in BCVA were observed between systemic therapies.

Conclusions: In conclusion severe manifestations, like Panuveitis, posterior uveitis, intermediate uveitis and retinal vasculitis required an aggressive treatment. In uveitis, a significant improvement in BCVA was observed after one year of follow-up.

Keywords: Biological therapy; Retinal vasculitis; Sarcoidosis; Uveitis; Visual acuity.