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Samalia PD, Lim LL, Niederer RL. Insights into the diagnosis and management of sarcoid uveitis: A review. Clin Exp Ophthalmol 2024; 52:294-316. [PMID: 38385625 DOI: 10.1111/ceo.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
Sarcoidosis is a leading cause of non-infectious uveitis that commonly affects middle-aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non-caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid-sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.
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Affiliation(s)
- Priya D Samalia
- Department of Opthalmology, Te Whatu Ora Southern, Dunedin, New Zealand
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lyndell L Lim
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Rachael L Niederer
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Chabchoub I, Damak C, Bouhamed M, Rekik M, Abid C, Frikha F, Kammoun S, Jemaa YB, Marzouk S, Bahloul Z. Central retinal vein occlusion : an uncommon complication in sarcoidosis. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:82-87. [PMID: 37851995 DOI: 10.2478/rjim-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Indexed: 10/20/2023]
Abstract
Sarcoidosis is a multi-system granulomatosis of unknown etiology, defined by the presence of epithelioid and gigantocellular granulomas, without caseous necrosis. Ocular sarcoidosis manifests mainly as bilateral granulomatous anterior uveitis. Occlusion of the central retinal vein in sarcoidosis is a rare manifestation, which is the particularity of our observation. We report the case of a patient presenting with unilateral central retinal vein occlusion associated with granulomatous anterior uveitis on the same side. Systemic manifestations and further investigations led to the diagnosis of sarcoidosis.
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Affiliation(s)
- Imen Chabchoub
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Chifa Damak
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Marwa Bouhamed
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mouna Rekik
- Ophthalmology Department, Habib Bourguiba Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Cyrine Abid
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Sonda Kammoun
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Yoldez Ben Jemaa
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Sameh Marzouk
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hédi Chaker Hospital, University of Sfax Faculty of Medicine 3029 Sfax, Tunisia
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Thapaliya S, Pant P, Paudel S, Ghimire S. Diagnosis of systemic sarcoidosis in a patient with bilateral granulomatous pan-uveitis: a case report. Ann Med Surg (Lond) 2024; 86:607-611. [PMID: 38222700 PMCID: PMC10783219 DOI: 10.1097/ms9.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Sarcoidosis is a systemic disease usually presenting with features of hilar lymphadenopathy like persistent cough, dyspnoea, cough, night sweats. However, its first and only manifestation can be ocular symptoms consistent with uveitis. Case presentation The authors present such association in a 53-year-old female who had ocular symptoms on and off, designated as uveitis. Despite medications, her symptoms rather flared up. On diagnostic assesement done years later, chest X-ray showed bilateral hilar lymphadenopathy, serum angiotensin-converting enzyme levels were also raised, and the diagnosis of systemic sarcoidosis was confirmed. Clinical discussion Eye involvement can occur way before the systemic presence of the disease is detected and can be present clinically as an isolated entity which makes diagnosis of underlying sarcoidosis a challenge. Conclusion Consideringsarcoidosis as one of the differential diagnosis when attending patients with non-resolving uveitis remains the mainstay of this report.
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Affiliation(s)
| | - Prashant Pant
- Department of Internal Medicine, Star Hospital, Sanepa, Lalitpur
| | - Sandip Paudel
- College of Medicine, Nepalese Army Institute of Health Science
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Lee JH, Han YE, Yang J, Kim HC, Lee J. Clinical manifestations and associated factors of uveitis in patients with pulmonary sarcoidosis: a case control study. Sci Rep 2023; 13:22380. [PMID: 38104161 PMCID: PMC10725472 DOI: 10.1038/s41598-023-49894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
Sarcoidosis, an idiopathic and inflammatory disease, affects various organs and can manifest as uveitis. Due to limited evidence, researchers investigated the risk factors associated with uveitis in patients with pulmonary sarcoidosis. A retrospective study was conducted on 71 pulmonary sarcoidosis patients, including 19 with uveitis and 52 without. Data on involved organs, imaging findings, spirometry, and analyses from blood and bronchoalveolar lavage fluid were collected. Logistic regression models were used for multivariate analysis. Among the 71 newly diagnosed pulmonary sarcoidosis patients, uveitis was observed in 19 patients (26.8%). No significant differences were found in clinical characteristics between patients with and without uveitis. Fewer patients with uveitis presented lung parenchymal lesions (P = 0.043). In multivariate analysis, skin lesions (aOR 7.619, 95% CI 1.277-45.472, P = 0.026) and ophthalmic symptoms (aOR 4.065, 95% CI 1.192-13.863, P = 0.025) were associated with uveitis. Absence of uveitis was related to lung parenchymal lesions (aOR 0.233, 95% CI 0.062-0.883, P = 0.032). Approximately one-quarter of patients with an initial diagnosis of pulmonary sarcoidosis were diagnosed with uveitis. Presence of skin lesions, ophthalmic symptoms, and absence of lung parenchymal lesions were related to uveitis. These results need to be clarified by further studies to confirm the clinical role of early ophthalmologic screening for pulmonary sarcoidosis patients with these factors.
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Affiliation(s)
- Jang Ho Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Kanakamedala AD, Maamari RN, Couch SM. Tattoo-associated lacrimal gland enlargement and sarcoidosis. Am J Ophthalmol Case Rep 2023; 32:101889. [PMID: 37521806 PMCID: PMC10371775 DOI: 10.1016/j.ajoc.2023.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To describe a case of tattoo-associated sarcoidosis presenting with cutaneous findings of tattoo granulomas and ophthalmic manifestation of isolated bilateral lacrimal gland enlargement. Observations A 35-year-old female presented with bilateral upper eyelid swelling for over a year. She reported no associated episodes of ocular pain or visual decline since onset of eyelid edema. On examination, the lacrimal glands were firm and enlarged bilaterally. Slit-lamp examination demonstrated no evidence of active or prior ocular inflammation. Further systemic examination revealed multiple raised papules within a 4-year-old chest/shoulder tattoo. Histopathology from a lacrimal gland biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions and importance The authors report a rare case of a 35-year-old presenting with isolated dacryoadenitis and tattoo granulomas found to be a tattoo-associated sarcoidosis. Although uveitis is a commonly described ocular manifestation in tattoo-associated sarcoidosis, few reports have described lacrimal gland enlargement as a presenting ophthalmic feature in tattoo-associated sarcoidosis.
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Bazewicz M, Heissigerova J, Pavesio C, Willermain F, Skrzypecki J. Ocular sarcoidosis in adults and children: update on clinical manifestation and diagnosis. J Ophthalmic Inflamm Infect 2023; 13:41. [PMID: 37721575 PMCID: PMC10507006 DOI: 10.1186/s12348-023-00364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
Sarcoidosis-associated uveitis, is the predominant ocular sarcoidosis presentation, which affects both adults and children. For adults, international ocular sarcoidosis criteria (IWOS) and sarcoidosis-associated uveitis criteria (SUN) are defined. However, for children they are not yet established internationally. Due to the specificity of pediatric manifestations of sarcoidosis, this task is even more challenging. In children, sarcoidosis is subdivided into Blau syndrome and early-onset sarcoidosis (BS/EOS) affecting younger children (< 5 years) and the one affecting older children with clinical presentation resembling adults. Differential diagnosis, clinical work-up as well as diagnostic criteria should be adapted to each age group. In this article, we review the clinical manifestation of sarcoidosis-associated uveitis in adults and children and the sensitivity and specificity of various ocular sarcoidosis diagnostic modalities, including chest X-ray and CT, FDG PET-CT, gallium-67 scintigraphy, bronchoalveolar lavage fluid, genetic testing for NOD2 mutations and serum biomarkers, such as ACE, lysozyme and IL2R.
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Affiliation(s)
- Magdalena Bazewicz
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital, National Health Service Foundation Trust London, London, UK
- University College London, London, UK
| | - François Willermain
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Janusz Skrzypecki
- Department of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
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Giorgiutti S, Jacquot R, El Jammal T, Bert A, Jamilloux Y, Kodjikian L, Sève P. Sarcoidosis-Related Uveitis: A Review. J Clin Med 2023; 12:jcm12093194. [PMID: 37176633 PMCID: PMC10178951 DOI: 10.3390/jcm12093194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Sarcoidosis is an inflammatory disease that involves the eyes in 10-55% of cases, sometimes without systemic involvement. All eye structures can be affected, but uveitis is the most common ocular manifestation and causes vision loss. The typical ophthalmological appearance of these uveitis is granulomatous (in cases with anterior involvement), which are usually bilateral and with synechiae. Posterior involvement includes vitritis, vasculitis and choroidal lesions. Tuberculosis is a classic differential diagnosis to be wary of, especially in people who have spent time in endemic areas. The diagnosis is based on histology with the presence of non-caseating epithelioid granulomas. However, due to the technical difficulty and yield of biopsies, the diagnosis of ocular sarcoidosis is often based on clinico-radiological features. The international criteria for the diagnosis of ocular sarcoidosis have recently been revised. Corticosteroids remain the first-line treatment for sarcoidosis, but up to 30% of patients require high doses, justifying the use of corticosteroid-sparing treatments. In these cases, immunosuppressive treatments such as methotrexate may be introduced. More recent biotherapies such as anti-TNF are also very effective (as they are in other non-infectious uveitis etiologies).
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Affiliation(s)
- Stéphane Giorgiutti
- Department of Clinical Immunology and Internal Medicine, National Center for Systemic Autoimmune Diseases (CNR RESO), Strasbourg University Hospital, 67000 Strasbourg, France
- INSERM UMR-S1109, Université de Strasbourg, 67000 Strasbourg, France
| | - Robin Jacquot
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
- Laboratory of Tissue Biology and Therapeutic Engineering, CNRS UMR5305, IBCP, University of Lyon, 69007 Lyon, France
| | - Arthur Bert
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université de Lyon 1, 69100 Villeurbanne, France
| | - Pascal Sève
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
- Pôle IMER, Hospices Civils de Lyon, 69002 Lyon, France
- The Health Services and Performance Research (EA 7425 HESPER), Université de Lyon, 69003 Lyon, France
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Sève P, Jacquot R, El Jammal T, Bert A, Jamilloux Y, Kodjikian L, Giorgiutti S. [Sarcoid uveitis: Ophthalmologist's and internist's viewpoints]. Rev Med Interne 2023; 44:112-122. [PMID: 36642624 DOI: 10.1016/j.revmed.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/01/2022] [Indexed: 01/15/2023]
Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis.
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Affiliation(s)
- P Sève
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Hospices civils de Lyon, Pôle IMER, 69003 Lyon, France; Université de Lyon, Lyon, France; University Lyon, University Claude Bernard-Lyon 1, HESPER EA 7425, 69008 Lyon, France.
| | - R Jacquot
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - T El Jammal
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - A Bert
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - Y Jamilloux
- Service de médecine interne, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - L Kodjikian
- Service d'ophtalmologie, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France
| | - S Giorgiutti
- Service d'immunologie clinique et médecine interne, CNR RESO, maladies auto-immunes et systémiques rares, Nouvel Hôpital civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Patnaik G, Sorokhaibam R, Biswas J. Unilateral Multifocal Choroidal Nodules as the Sole Initial Manifestation of Systemic Sarcoidosis - Diagnostic Role of PET-CT Scan. Ocul Immunol Inflamm 2023; 31:194-198. [PMID: 34726547 DOI: 10.1080/09273948.2021.1986545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To present a case of multifocal choroidal nodules as the sole manifestation of systemic sarcoidosis with role of PET- CT Scan. METHODS Retrospective observational case report. RESULTS A 66 -year-old male presented with blurring of vision in left eye since 2 weeks. He had no systemic complaints. On fundus examination in left eye showed three well -defined choroidal nodules inferotemporal to optic disc. A negative mantoux test, elevated serum angiotensin converting enzyme level and PET scan analysis helped to clinch the diagnosis of sarcoid uveitis. The choroidal nodules completely resolved after a course of oral corticosteroid. CONCLUSION Multifocal choroidal nodules can be the sole manifestation of systemic sarcoidosis.
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Affiliation(s)
- Gazal Patnaik
- Fellow Uvea and Medical Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Reena Sorokhaibam
- Fellow Uvea and Medical Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Director of Uvea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Mahmoudzadeh R, Gopal A, Soares R, Dunn JP. Unilateral Retinal Arteritis and Macroaneurysm in Sarcoidosis. Ocul Immunol Inflamm 2022; 30:1901-1905. [PMID: 34464228 DOI: 10.1080/09273948.2021.1970780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sarcoidosis, an idiopathic systemic disorder characterized by noncaseating granulomas, is often associated with granulomatous uveitis. Anterior segment involvement can present with mutton-fat keratic precipitates, anterior chamber cell, and iris nodules. Sarcoid associated posterior uveitis may present with vitritis, retinal vasculitis, and choroidal lesions. CASE SUMMARY Sarcoid-associated retinal vasculitis is classically thought of as predominantly involving veins, but in this case report we describe a 76-year-old Caucasian woman presenting with bilateral posterior uveitis, unilateral optic nerve head granuloma, and retinal arteritis as the first manifestation of ocular involvement in systemic sarcoidosis. CONCLUSION This case describes the uncommon first manifestation of ocular involvement in systemic sarcoidosis presenting with unilateral retinal arteritis, macroaneurysms and optic nerve head granuloma.
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Affiliation(s)
- Raziyeh Mahmoudzadeh
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Anand Gopal
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Rebecca Soares
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - James P Dunn
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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Hage DG, Wahab CH, Kheir WJ. Choroidal sarcoid granuloma: a case report and review of the literature. J Ophthalmic Inflamm Infect 2022; 12:31. [PMID: 36173484 PMCID: PMC9521566 DOI: 10.1186/s12348-022-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. Observations We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. Conclusion Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.
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Affiliation(s)
- Dany G Hage
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.,Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Charbel H Wahab
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
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Management of Non-Infectious Uveitis, a Selection of Topical Items Updating. J Clin Med 2022; 11:jcm11195558. [PMID: 36233426 PMCID: PMC9572930 DOI: 10.3390/jcm11195558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
First of all, we would like to thank all of the authors for their contributions and the editorial staff who enabled the achievement of this «Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges» Special Issue [...]
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Could different aqueous humor and plasma cytokine profiles help differentiate between ocular sarcoidosis and ocular tuberculosis? Inflamm Res 2022; 71:949-961. [PMID: 35763079 DOI: 10.1007/s00011-022-01601-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/07/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE AND DESIGN A cross-sectional single-center study was conducted to assess cytokine levels in aqueous humor (AH) and plasma of three different uveitis entities: definite ocular sarcoidosis (OS), definite OS associated with QuantiFERON®-TB Gold test positivity (Q + OS) and presumed tubercular uveitis (TBU). SUBJECTS Thirty-two patients (15 OS, 5 Q + OS, 12 TBU) were included. METHODS Quantification of selected cytokines was performed on blood and AH samples collected before starting any treatment. Statistical analysis was conducted using the Kruskal-Wallis test, the Mann-Whitney or Fisher test and the Principal Component Analysis (PCA). RESULTS IL-6, IL-8 and IP-10 levels were higher in AH samples than in peripheral blood. In AH samples, BLC, IL-8 and IP-10 were significantly higher in definite OS than in presumptive TBU. There were no statistically significant differences in terms of cytokine levels between Q + OS and presumptive TBU. PCA showed a similar cytokine pattern in the latter two groups (IFNγ, IL-15, IL-2, IP-10, MIG), while the prevalent expression of BLC, IL-10 and MIP-3 α was seen in definite OS. CONCLUSIONS The different AH and plasma cytokine profiles observed in OS compared to Q + OS and TBU may help to differentiate OS from TBU in overlapping clinical phenotypes of granulomatous uveitis (Q + OS).
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Yates WB, McCluskey PJ, Fraser CL. Neuro-ophthalmological manifestations of sarcoidosis. J Neuroimmunol 2022; 367:577851. [DOI: 10.1016/j.jneuroim.2022.577851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
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15
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Lai IW, Lin CP, Hsieh YT, Yeh PT. Clinical manifestations and risk factors for poor visual outcomes of ocular sarcoidosis in Taiwan. J Formos Med Assoc 2022; 121:1560-1566. [PMID: 35027256 DOI: 10.1016/j.jfma.2021.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/23/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess ocular involvement in sarcoidosis and to analyze the manifestations of ocular sarcoidosis (OS) in Taiwan. METHODS A retrospective review was performed in 364 patients diagnosed as sarcoidosis at National Taiwan University Hospital from 2015 to 2019. The OS diagnosis was based on the revised criteria of International Workshop on Ocular Sarcoidosis. Demographics, clinical manifestations, treatment and effects, complications, visual outcomes and risk factors of poor vision (<20/200) were analyzed. RESULTS A total of 122 eyes of 66 patients (13 males and 53 females) with OS were identified. Bilateral involvement accounted for 84.8%. Thirty-five patients were diagnosed with definite OS, 14 with presumed OS and 17 with probable OS. The average age was 51.9 ± 14.1 years, with no significant difference in sex. Most patients presented with panuveitis (61 eyes, 50.0%) and posterior uveitis (52 eyes, 42.6%). Systemic steroid was the mainstay treatment, and immunosuppressants or anti-metabolic agents were supplemented. Common complications included cataract (50.8%), ocular hypertension/glaucoma (25.4%) and posterior synechiae (20.5%). Forty-three eyes (36.1%) and 74 eyes (62.2%) had a final vision of 20/20 and 20/40 or better, respectively. The causes of poor visual outcome were diverse, and generalized estimating equations analysis indicated that female and poor initial vision were risk factors. CONCLUSION Uveitis is an early sign of sarcoidosis and it might result in several complications. The overall visual outcomes were good if patients received proper treatment. Both poor initial vision and females that tended to have more severe complications were associated with poor outcome.
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Affiliation(s)
- I-Wen Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
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16
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MT C, Baikunje N, Y. SK, K. SB, Bajaj D, Hosmane GB. An Interesting Case of Bilateral Hilar Lymphadenopathy Presented with Visual Impairment. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1736454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractSarcoidosis is a systemic granulomatous disease of unknown etiology. It primarily affects the lungs and lymphatics; however, the presentation is not always pulmonary. Uveitis is the presenting symptom in 5% of patients, predominantly in females. Cystoid macular edema is the most important sight-threatening sequela of ocular sarcoidosis. Histopathological evidence of noncaseating epithelioid granulomas from a biopsy is the gold standard for the diagnosis of ocular sarcoidosis. Diagnosis of sarcoidosis is made by exclusion of other causes of granulomatous disease, mainly tuberculosis and fungal infection and documentation of involvement of at least one additional organ system. The authors present a case of a patient with sarcoidosis involving lungs and eyes, who had uveitis as an initial presentation.
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Affiliation(s)
- Chandramouli MT
- Department of Pulmonary Medicine, K S Hegde Medical Academy, Mangalore, India
| | | | - Sunil Kumar Y.
- Department of Pathology, K S Hegde Medical Academy, Mangalore, India
| | | | - Darshan Bajaj
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, India
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17
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Joltikov KA, Lobo-Chan AM. Epidemiology and Risk Factors in Non-infectious Uveitis: A Systematic Review. Front Med (Lausanne) 2021; 8:695904. [PMID: 34568364 PMCID: PMC8461013 DOI: 10.3389/fmed.2021.695904] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose: Non-infectious uveitis is a leading cause of vision loss in the developed world. The purpose of this systematic review is to investigate the epidemiology and risk factors of non-infectious uveitis over the last 50 years. Methods: A systematic literature search of Pubmed/MEDLINE database was performed in the 50-year period from January 1971 to January 2021, according to the PRISMA guidelines. Studies that assessed the epidemiology and risk factors for non-infectious uveitis were included. Results: Few epidemiologic studies focus specifically on non-infectious uveitis. In the Unites States, the estimated prevalence of non-infectious uveitis is 121/100,000. The incidence and prevalence varies considerably worldwide. Females and the working age group (20–50 years) appear to be the most affected. Smoking and vitamin D deficiency are the biggest risk factors for non-infectious uveitis, while pregnancy appears to be protective. Additional risk factors include presence of other autoimmune diseases (thyroid disease, diabetes, celiac), pre-eclampsia/eclampsia, psychological stress, and certain medications (bisphosphonates, immune checkpoint inhibitors, female hormone therapy, and etanercept). Discussion: Our systematic review summarizes the incidence and prevalence of non-infectious uveitis and associated modifiable and non-modifiable risk factors.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Ann-Marie Lobo-Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, United States
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18
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Fidler LM, Balter M, Fisher JH, Stanbrook MB, To T, Kohly R, Gershon AS. Ophthalmologic assessments in patients with newly diagnosed sarcoidosis: An observational study from a universal healthcare system. Respir Med 2021; 187:106575. [PMID: 34438352 DOI: 10.1016/j.rmed.2021.106575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Consensus guidelines for the management of sarcoidosis recommend screening eye examinations for all patients, even in those without ocular symptoms. We aimed to determine the proportion of sarcoidosis patients that complete ophthalmologic evaluations and factors associated with their performance. METHODS We identified patients with sarcoidosis using population health services data from Ontario, Canada between 1991 and 2019. Sarcoidosis was defined by ≥ 2 physician visits for sarcoidosis within a two-year period. Ophthalmologic evaluations were based on an optometrist or ophthalmologist visit within the year prior or two years following the diagnosis. We estimated correlations between the number of eye care professionals and proportion of sarcoidosis patients completing ophthalmologic assessments within regional health units. We evaluated for associations between ophthalmologic screening and patient characteristics using multivariable logistic regression. RESULTS We identified 21,679 patients with sarcoidosis in Ontario. An ophthalmologic evaluation was performed in 14,751 (68.0%), with a similar number of individuals seeing ophthalmologists and optometrists (43.7% vs. 42.2%). The percentage of sarcoidosis patients undergoing an ophthalmologic evaluation within corresponding regional health units was moderately correlated with the number of practicing ophthalmologists (r = 0.64, p = 0.01), but not the number of optometrists (r = 0.08, p = 0.77). Patients who were older [OR per year 1.02 (95% CI 1.01-1.02), p < 0.001] and female [OR 1.54 (95% CI 1.44-1.63), p < 0.001] were more likely to complete ophthalmologic evaluations. Immigrants to Canada were less likely to undergo ophthalmologic assessments [OR 0.66 (95% CI 0.60-0.73), p < 0.001]. CONCLUSIONS Most patients with sarcoidosis complete ophthalmologic examinations, though a substantial proportion does not. Young adults, men and immigrants were less likely to complete ophthalmologic evaluations. Limited access to ophthalmologists may at least in part explain why some sarcoidosis patients fail to complete ophthalmologic screening.
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Affiliation(s)
- Lee M Fidler
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Meyer Balter
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jolene H Fisher
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Matthew B Stanbrook
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Teresa To
- ICES, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Radha Kohly
- Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea S Gershon
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada
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19
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Shen D, Ono K, Do Q, Ohyama H, Nakamura K, Obata K, Ibaragi S, Watanabe K, Tubbs RS, Iwanaga J. Clinical anatomy of the inferior labial gland: a narrative review. Gland Surg 2021; 10:2284-2292. [PMID: 34422599 DOI: 10.21037/gs-21-143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022]
Abstract
Objective In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective. Background Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland. Methods A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland". Conclusions The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.
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Affiliation(s)
- Daniel Shen
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Kisho Ono
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Quang Do
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Hiroe Ohyama
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ken Nakamura
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
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20
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Evaluation of Lamina Cribrosa by Using Enhanced Depth Imaging Optical Coherence Tomography in Ocular Sarcoidosis during Quiescent Phase. Optom Vis Sci 2021; 98:137-142. [PMID: 33534381 DOI: 10.1097/opx.0000000000001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Enhanced depth imaging optical coherence tomography is a useful method to allow for the evaluation of deep ocular structures, such as choroid and lamina cribrosa (LC), which are affected by ocular diseases. We hypothesized that choroidal and optic nerve inflammation in patients with ocular sarcoidosis (OS) might affect the LC structure. PURPOSE This study aimed to evaluate changes in the LC and anterior LC depth (ALCD) in patients with OS. METHODS Forty-eight eyes of 26 patients with OS who received the treatment of panuveitis and were in the quiescent phase for at least 6 months were included in the study. Thirty healthy subjects' randomly selected eyes were selected as a control group. Eyes with OS were divided into two subgroups according to the presence (OS eyes with glaucoma [OSWG], n = 23) or absence of glaucoma (OS eyes without glaucoma [OSWOG], n = 25). The LC thickness, ALCD, and peripapillary choroidal thickness were measured using enhanced depth imaging optical coherence tomography in eyes with OS and in controls. RESULTS The mean LC thickness was found significantly thinner in both OSWG and OSWOG eyes compared with the healthy controls (P < .001 and P = .001, respectively). The mean ALCD was found significantly higher in OSWG eyes (462 ± 65 μm) compared with OSWOG eyes (417 ± 58 μm) and the healthy control eyes (397 ± 59 μm; P = .03 and P = .001, respectively). The average peripapillary choroidal thickness was found to be significantly thinner in OSWG eyes compared with the control eyes (P = .05). CONCLUSIONS The present study revealed that OS is associated with a thinned LC independent of the presence of glaucoma. The degenerative changes in the LC, which is the transition point of the retinal nerve fibers, may cause long-term visual dysfunction in OS. These degenerative changes should be prevented by controlling inflammation with early diagnosis and treatment in patients with OS.
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21
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Peripheral Retinal Neovascularization in a Patient with Sarcoidosis and Cocaine-Associated Autoimmunity. Case Rep Ophthalmol Med 2021; 2021:9923260. [PMID: 34158981 PMCID: PMC8187046 DOI: 10.1155/2021/9923260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
A 63-year-old African-American female with history of sarcoidosis (lymph node biopsy proven) and cocaine abuse for 8 years was referred to us because of new floater. Her ocular history was unremarkable except for vague complaints of visual disturbance during a hospital admission in 2016. On presentation, her visual acuity was 20/400 in the right eye and 20/30 in the left eye. Dilated fundus exam and multimodal imaging showed thick epiretinal membrane (ERM) superior to optic nerve head causing a lamellar macular hole and intra retinal edema in the right eye, a full thickness macular hole, and peripheral neovascularization in the left eye. Peripheral vasculitis was appreciated in both eyes and peripheral neovascularization in the left eye on fluorescein angiography. The patient underwent laser therapy, and the new vessels regressed in the left eye without any changes in systemic medications. Multiple factors may contribute to retinal vasculitis and neovascularization including sarcoidosis, cocaine abuse, and other undiagnosed systemic vasculitis, which makes this case a mystery.
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22
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Richard M, Jamilloux Y, Courand PY, Perard L, Durel CA, Hot A, Burillon C, Durieu I, Gerfaud-Valentin M, Kodjikian L, Seve P. Cardiac Sarcoidosis Is Uncommon in Patients with Isolated Sarcoid Uveitis: Outcome of 294 Cases. J Clin Med 2021; 10:jcm10102146. [PMID: 34063547 PMCID: PMC8156086 DOI: 10.3390/jcm10102146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, concerns have been raised about an increased risk of cardiac sarcoidosis in patients with sarcoid uveitis. While cardiac sarcoidosis has a high mortality burden, there is still a lack of precise data on this association. The objective of this study is to describe the frequency and type of cardiac complications associated with sarcoidosis of a large cohort of patients with sarcoid uveitis. We analyzed the cardiac outcomes of a monocentric retrospective cohort of consecutive adults with a diagnosis of sarcoid uveitis between January 2004 and March 2020 in a tertiary French university hospital. A total of 294 patients with a final diagnosis of sarcoid uveitis were included. At final follow-up, seven (2.4%) patients of the cohort had cardiac sarcoidosis. Cardiac sarcoidosis was more frequent among patients with previously reported systemic sarcoidosis (p = 0.008). The prevalence of cardiac sarcoidosis among patients with sarcoid uveitis is low, but patients with previously diagnosed sarcoidosis or those who develop systemic sarcoidosis during follow-up appear to be at increased risk.
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Affiliation(s)
- Mael Richard
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (M.R.); (Y.J.); (M.G.-V.)
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (M.R.); (Y.J.); (M.G.-V.)
| | - Pierre-Yves Courand
- Department of Cardiology, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Creatis, Université Claude Bernard Lyon 1, 69004 Lyon, France;
| | - Laurent Perard
- Department of Internal Medicine, Hôpital Saint-Joseph Saint-Luc, 69007 Lyon, France;
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France;
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France;
| | - Carole Burillon
- Department of Ophthalmology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France;
| | - Isabelle Durieu
- Department of Internal and Vascular Medicine, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France;
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (M.R.); (Y.J.); (M.G.-V.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France;
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
| | - Pascal Seve
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (M.R.); (Y.J.); (M.G.-V.)
- Hospices Civils de Lyon, Pôle IMER, F-69003 Lyon, France
- University Claude Bernard-Lyon 1, HESPER EA 7425, F-69008 Lyon, France
- Correspondence: ; Tel.: +33-426-732-630
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23
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Suzuki K, Namba K, Mizuuchi K, Iwata D, Ito T, Hase K, Kitaichi N, Ishida S. Validation of systemic parameters for the diagnosis of ocular sarcoidosis. Jpn J Ophthalmol 2021; 65:191-198. [PMID: 33420542 DOI: 10.1007/s10384-020-00793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Ocular sarcoidosis is diagnosed based on suggestive intraocular findings and systemic investigations. In this study, we assessed the clinical usefulness of systemic parameters in the diagnosis of ocular sarcoidosis. STUDY DESIGN A retrospective study. METHODS This study included 79 cases (19 men, 60 women) with ocular sarcoidosis who visited Hokkaido University Hospital from 2011 to 2015 and were followed up for more than one year. The control group was 91 cases of other uveitis (38 men, 53 women). All cases underwent blood examination for the measurement of angiotensin-converting enzyme (ACE), Krebs von den Lungen-6 (KL-6), soluble interleukin-2 receptor (sIL-2R), and calcium (Ca) levels. Bilateral hilar lymphadenopathy (BHL) was also examined by plain chest X-ray and contrasting chest computed tomography (CT). RESULTS The sensitivity for sIL-2R (76.4%) was higher than for ACE (37.7%), KL-6 (26.3%), and Ca (11.8%), although all showed high specificity: ACE (97.5%), KL-6 (96.2%), sIL-2R (93.8%), and Ca (95.1%). From these results, the Youden index of sIL-2R (0.70) was higher than that of ACE (0.35), KL-6 (0.26), and Ca (0.07). Imaging tests revealed better detection of BHL by contrasting chest CT (82.7%) than by plain chest X-ray (29.5%). CONCLUSION The present findings indicate that the systemic parameters, particularly serum sIL-2R levels and BHL on contrasting chest CT, are useful biomarkers for the diagnosis of ocular sarcoidosis.
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Affiliation(s)
- Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takako Ito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Keitaro Hase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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24
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Bienvenu FH, Tiffet T, Maucort-Boulch D, Gerfaud-Valentin M, Kodjikian L, Perard L, Burillon C, Durel CA, Hot A, Jamilloux Y, Seve P. Factors Associated with Ocular and Extraocular Recovery in 143 Patients with Sarcoid Uveitis. J Clin Med 2020; 9:jcm9123894. [PMID: 33266254 PMCID: PMC7761190 DOI: 10.3390/jcm9123894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Sarcoidosis is one of the leading causes of uveitis. To date, no studies have assessed the factors specifically related with recovery in ocular sarcoidosis. In this study, we aimed to determine factors associated with ocular and extraocular recovery in patients with sarcoid uveitis. Methods: A retrospective study of sarcoid uveitis, with a three-year minimum follow-up in Lyon University Hospital between December 2003 and December 2019. Patients presented biopsy-proven sarcoidosis or presumed sarcoid. Recovery was defined by a disease-free status, spontaneously or despite being off all treatments for three years or more. Results: 143 patients were included: 110 with biopsy-proven and 33 with presumed sarcoid uveitis. Seventy-one percent were women, the median age at presentation was 53 years, and 71% were Caucasian. Chronic uveitis was the main clinical presentation (75%), mostly panuveitis (48%) with bilateral involvement (82%). After a median follow-up of 83.5 months, recovery was reported in 26% of patients. In multivariable analysis, Caucasian ethnicity (p = 0.007) and anterior uveitis (p = 0.008) were significantly associated with recovery, while increased intraocular pressure was negatively associated (p = 0.039). Conclusion: In this large European cohort, one quarter of patients recovered. Caucasian ethnicity and anterior uveitis are associated with ocular and extraocular recovery.
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Affiliation(s)
- Francois-Henri Bienvenu
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, 69004 Lyon, France; (F.-H.B.); (M.G.-V.); (Y.J.)
| | - Théophile Tiffet
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France; (T.T.); (D.M.-B.)
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France; (T.T.); (D.M.-B.)
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100 Villeurbanne, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, 69004 Lyon, France; (F.-H.B.); (M.G.-V.); (Y.J.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, 69004 Lyon, France;
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
| | - Laurent Perard
- Department of Internal Medicine, Centre Hospitalier Saint-Joseph Saint-Luc, Université Claude Bernard Lyon 1, 69007 Lyon, France;
| | - Carole Burillon
- Department of Ophthalmology, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, 69003 Lyon, France;
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, 69003 Lyon, France; (C.-A.D.); (A.H.)
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, 69003 Lyon, France; (C.-A.D.); (A.H.)
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, 69004 Lyon, France; (F.-H.B.); (M.G.-V.); (Y.J.)
| | - Pascal Seve
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, 69004 Lyon, France; (F.-H.B.); (M.G.-V.); (Y.J.)
- Hospices Civils de Lyon, Pôle IMER, Lyon F-69003, France
- Correspondence: ; Tel.: +33-426-732638; Fax: +33-426-732637
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Laura D, Lee Y, Farhangi M, Salamo O, Mirsaeidi M, Goldhardt R, Galor A. Ocular Manifestations of Sarcoidosis in a South Florida Population. Clin Ophthalmol 2020; 14:3741-3746. [PMID: 33173272 PMCID: PMC7648141 DOI: 10.2147/opth.s278373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the ocular manifestations of sarcoidosis in a South Florida population and identify risk factors for the presence of ocular disease. Design Retrospective consecutive case series. Methods Medical charts of individuals with sarcoidosis seen in the University of Miami pulmonary department were reviewed for ocular disease. Odds ratios were used to identify risk factors for ocular sarcoidosis. Results Fourteen of 108 individuals with sarcoidosis had ocular involvement. The mean age of the 14 individuals was 56±15 years. Seventy-one percent were female, 50% were black, and 21% were Hispanic. Twelve had uveitis of which panuveitis was the most common subtype. Five had ≤20/70 vision in at least one eye due to uveitis. Neurosarcoidosis was a risk factor for ocular sarcoidosis (OR 6.14, p=0.03, 95% CI 1.21–31.09). Conclusion Ocular manifestations occurred in a minority of individuals in a pulmonary sarcoidosis clinic in South Florida. Uveitis was the most common ocular manifestation. Neurosarcoidosis was a risk factor for ocular involvement.
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Affiliation(s)
- Diana Laura
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL 33136, USA
| | - Yonghoon Lee
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL 33136, USA
| | - Monika Farhangi
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL 33136, USA
| | - Oriana Salamo
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA
| | - Mehdi Mirsaeidi
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Department of Pulmonology, University of Miami, Miami, FL 33125, USA
| | - Raquel Goldhardt
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL 33136, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL 33125, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL 33136, USA
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Bolletta E, Mastrofilippo V, Invernizzi A, Aldigeri R, Spaggiari L, Besutti G, Borrelli R, Lo Coco F, Ricchetti T, Rapicetta C, Cavazza A, Musci G, De Simone L, Gozzi F, Salvarani C, Pipitone N, Paci M, Cimino L. Clinical Relevance of Subcentimetric Lymph Node Biopsy in the Diagnosis of Ocular Sarcoidosis. Ocul Immunol Inflamm 2020; 30:717-720. [PMID: 33016855 DOI: 10.1080/09273948.2020.1817503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical relevance of subcentimetric lymph node biopsy via mediastinoscopy in patients with presumed ocular sarcoidosis (OS). METHODS Retrospective study of consecutive patients who underwent biopsy via mediastinoscopy for suspected OS. The biopsy outcomes and clinical features of patients with subcentimetric nodes and of those with lymph nodes >1 cm were compared. RESULTS A total of 67 patients with presumed OS were included. Forty-two patients (63%) had lymph nodes ≥1 cm in diameter, while 25(37%) showed subcentimetric lymph nodes. Biopsy was consistent with sarcoidosis in 83% of patients with lymph nodes ≥1 cm and in 76% of patients with subcentimetric lymph nodes (p = .60). Patients with OS who had subcentimetric lymph nodes had less lymphopenia (p = .01), lower lysozyme values (p = .03) and a longer diagnostic delay compared to those with larger lymph nodes. CONCLUSIONS The biopsy of subcentimetric lymph nodes via mediastinoscopy may provide a histological diagnosis and reduce diagnostic delay.
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Affiliation(s)
- Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, University of Sydney, Sydney, Australia
| | | | - Lucia Spaggiari
- Department of Radiology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- Department of Radiology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Borrelli
- Thoracic Surgery Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Lo Coco
- Thoracic Surgery Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Tommaso Ricchetti
- Thoracic Surgery Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Thoracic Surgery Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Musci
- Pathology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Division of Rheumatology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Rheumatology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Nicolò Pipitone
- Department of Rheumatology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Paci
- Pathology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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27
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Sève P, Jamilloux Y, Tilikete C, Gerfaud-Valentin M, Kodjikian L, El Jammal T. Ocular Sarcoidosis. Semin Respir Crit Care Med 2020; 41:673-688. [PMID: 32777852 DOI: 10.1055/s-0040-1710536] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France.,Hospices Civils de Lyon, Pôle IMER, Lyon, France.,University Claude Bernard-Lyon 1, HESPER EA 7425, Univ. Lyon, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Caroline Tilikete
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Laurent Kodjikian
- Neurology D and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.,Université de Lyon, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028 CNRS UMR5292, Team ImpAct, Bron, France.,Department of Ophthalmology, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
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28
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Kim M, Kim SA, Park W, Kim RY, Park YH. Intravitreal Dexamethasone Implant for Treatment of Sarcoidosis-Related Uveitis. Adv Ther 2019; 36:2137-2146. [PMID: 31140122 DOI: 10.1007/s12325-019-00989-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the efficacy and safety of intravitreal dexamethasone implant injection in the management of sarcoidosis-related uveitis. METHODS A retrospective analysis was performed of the efficacy and safety of intravitreal dexamethasone implant injection for indications such as intractable vitritis, vasculitis, or cystoid macular edema. RESULTS This study comprised 20 patients with sarcoidosis-related uveitis. A single injection was performed in 13 eyes (65%) and 35% required more than 2 injections during the follow-up period [median 16.5 months (range 6-32)]. The best-corrected visual acuity showed significant improvement at 1 month (P = 0.004) and 3 months (P = 0.001), but there was no significance at 6 months after implant injection (P = 0.186). One month after treatment, the central macular thickness decreased to 278.95 ± 52.20 μm (P = 0.023). It further decreased to 274.70 ± 55.88 μm at 3 months (P = 0.027), but there was no significance at 6 months (280.65 ± 64.48 μm, P = 0.074).The anterior chamber cell grade (P = 0.003) and vitreous haze (P = 0.001) were significantly decreased for up to 6 months after a single implant injection. The most common ocular complication was worsening of cataracts during the first 6 months. CONCLUSION Intravitreal dexamethasone implant injection is efficacious in reducing anterior chamber inflammation, vitreous haze, and cystoid macular edema in patients with sarcoidosis-related uveitis. Considering that sarcoidosis shows a chronic course of disease in a significant proportion of cases, intravitreal dexamethasone implant injection is a possible option to relieve intraocular inflammation.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Ah Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wookyung Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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29
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Grumet P, Kerever S, Gilbert T, Kodjikian L, Gerfaud-Valentin M, De Parisot A, Jamilloux Y, Sève P. Clinical and etiologic characteristics of de novo uveitis in patients aged 60 years and above: experience of a French tertiary center. Graefes Arch Clin Exp Ophthalmol 2019; 257:1971-1979. [PMID: 31312906 DOI: 10.1007/s00417-019-04411-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To describe the characteristics of de novo uveitis in patients ≥ 60 years old. METHODS Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared. RESULTS A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group. CONCLUSION In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
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Affiliation(s)
- P Grumet
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - S Kerever
- Service d'Anesthésie-Réanimation, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Gilbert
- Service de Gériatrie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - L Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - M Gerfaud-Valentin
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - A De Parisot
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - Y Jamilloux
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - P Sève
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France. .,Hospices Civils de Lyon, Pôle IMER, F-69003, Lyon, France. .,Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
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30
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Coulon C, Kodjikian L, Rochepeau C, Perard L, Jardel S, Burillon C, Broussolle C, Jamilloux Y, Seve P. Ethnicity and association with ocular, systemic manifestations and prognosis in 194 patients with sarcoid uveitis. Graefes Arch Clin Exp Ophthalmol 2019; 257:2495-2503. [PMID: 31302765 DOI: 10.1007/s00417-019-04415-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the ophthalmological and extra-ophthalmological clinical characteristics and visual prognosis of patients with sarcoid uveitis in different ethnic groups. METHODS We retrospectively analysed the data from patients with sarcoid uveitis seen at two departments of Ophthalmology between December 2003 and December 2017. Patients presented biopsy-proven sarcoidosis and/or presumed sarcoid uveitis based on the following criteria: compatible thoracic imaging, associated with elevated angiotensin-conversion enzyme (ACE) and/or lymphocytic alveolitis on bronchoalveolar lavage fluid analysis (> 15% lymphocytes and CD4/CD8 > 3.5). Ophthalmological and general characteristics, as well as visual and global prognoses, were compared in three pre-defined ethnic groups: White Europeans, North Africans and Afro-Caribbeans. RESULTS A total of 194 patients were included: 145 with biopsy-proven and 49 with presumed sarcoid uveitis. Overall, 68% were White Europeans while 20.6% were North Africans and 11.3% were Afro-Caribbeans. Sixty-nine per cent were women and the median age at presentation was 52.1 years. Median ages at first ocular manifestation of the disease in Afro-Caribbeans and North Africans were respectively 34.3 and 43.1 years, while it was 57.8 years in White Europeans (p < 0.001). Ocular involvement was bilateral in 77.8% (n = 151) of the cases and nearly half of the patients had panuveitis (48.5%). Anterior uveitis was more frequent in Afro-Caribbeans (59.1%; p < 0.0001), while White Europeans presented more frequently with intermediate uveitis. There was a significantly higher frequency of systemic involvement of sarcoidosis in North Africans while White Europeans showed a higher frequency of isolated ocular involvement at onset and during follow-up. Afro-Caribbeans, who had a complete visual recovery in 72.7% of the cases, had a better visual prognosis than other ethnic groups (p = 0.025). CONCLUSION In this large European series of sarcoid uveitis, we observed ethnicity-related differences regarding uveitis clinical presentation and visual outcome. Although good overall, the visual prognosis seems to be better in Afro-Caribbeans than in other ethnic groups.
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Affiliation(s)
- Charlotte Coulon
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Villeurbanne, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Villeurbanne, France
| | - Cédric Rochepeau
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Perard
- Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France
| | - Sabine Jardel
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Carole Burillon
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Ophthalmology, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christiane Broussolle
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- University Claude Bernard Lyon 1, Villeurbanne, France. .,Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France. .,Service de Médecine Interne, Hôpital de la Croix-Rousse, France; Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France.
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Roqai YC, Ajhoun Y, Laaribi N, Belfaiza S, Mouzari Y, El Asri F, Reda K, Oubaaz A. �Œdème papillaire isolé révélant une sarcoïdose oculaire. Pan Afr Med J 2019; 32:132. [PMID: 31223420 PMCID: PMC6560945 DOI: 10.11604/pamj.2019.32.132.18253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/21/2019] [Indexed: 12/04/2022] Open
Abstract
La sarcoïdose est une granulomatose multisystémique d'étiologie inconnue, défini par la présence de granulomes épithélioïdes et gigantocellulaires, sans nécrose caséeuse. La sarcoïdose oculaire se manifeste essentiellement par une uvéite antérieure granulomateuse et bilatérale. L'atteinte postérieure au cours de la sarcoïdose oculaire est rare et se manifeste par des périphlébites ou une atteinte choroïdienne. L'œdème papillaire isolé au cours est un tableau atypique d'où la particularité de notre observation. L'atteinte postérieure est un élément de mauvais pronostic menaçant le pronostic visuel, une prise en charge rapide en collaboration avec les pneumologues par corticothérapie systémique permet d'améliorer le pronostic visuel et limiter les complications.
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Affiliation(s)
- Yasmine Chaoui Roqai
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Yousra Ajhoun
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Nisrine Laaribi
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Soukaina Belfaiza
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Yassine Mouzari
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Fouad El Asri
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Karim Reda
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
| | - Abdelbarre Oubaaz
- Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie Université Mohammed V, Rabat, Maroc
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Sarcoidosis-related Uveitis: Clinical Presentation, Disease Course, and Rates of Systemic Disease Progression After Uveitis Diagnosis. Am J Ophthalmol 2019; 198:30-36. [PMID: 30243930 DOI: 10.1016/j.ajo.2018.09.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To document the clinical presentation, treatment, and visual outcome of sarcoid uveitis and to determine the timing and potential risk factors of sarcoidosis progression to symptomatic systemic disease from the time of sarcoid uveitis diagnosis. DESIGN Retrospective, interventional case series. METHODS Subjects: Patients with dual diagnoses of uveitis and presumed/biopsy-proven sarcoidosis. PROCEDURE Retrospective review of 143 patient records from the Royal Victorian Eye and Ear Hospital and Eye Surgery Associates in Melbourne, Australia, between October 1990 and April 2014 coded with the dual diagnoses of uveitis and sarcoidosis. Only patients with uveitis and presumed or biopsy-proven sarcoidosis (N = 113) were included. MAIN OUTCOME MEASURES Ascertainment of rate and time (months) to the development of symptomatic systemic sarcoidosis from uveitis onset; comparison of the patient demographics, characteristics of uveitis, treatment, and visual outcome between those who developed systemic sarcoidosis and those who remained systemically asymptomatic. RESULTS Uveitis was the initial presenting complaint of sarcoidosis in 78.8% (n = 89). Twenty-three patients had concurrent undiagnosed systemic disease at presentation and 29 subsequently developed symptomatic sarcoidosis in an organ uninvolved at uveitis onset. The median time to the development of symptomatic systemic sarcoidosis was 12 months. No statistically significant association was ascertained between any particular uveitis characteristic and extraocular sarcoidosis progression. CONCLUSION Uveitis was the initial presentation of sarcoidosis in the vast majority of our subjects. Concurrent undiagnosed systemic sarcoidosis was common at the time of uveitis onset. A high index of suspicion for subsequent systemic progression should also be maintained, especially within the first 5 years of the uveitis diagnosis.
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33
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Groen-Hakan F, Eurelings L, Rothova A, van Laar J. Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis. Br J Ophthalmol 2018; 103:1296-1300. [DOI: 10.1136/bjophthalmol-2018-313212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 11/04/2022]
Abstract
Background/aimsThe diagnostic properties of conventional diagnostic tests (ACE and chest radiography) for sarcoidosis-associated uveitis are not ideal. The diagnostic value of lymphopaenia for sarcoidosis-associated uveitis is investigated.MethodsA retrospective study of 191 consecutive patients with a first uveitis episode visiting the ophthalmology department (Erasmus Medical Center, Rotterdam, The Netherlands). Receiver operating characteristics (ROC) analysis was performed and compared with known ROC values from literature of conventional diagnostic tests for sarcoidosis-associated uveitis. An ideal cut-off was determined for lymphopaenia by calculation of the highest Youden index.ResultsOut of all patients with first uveitis attack, 32/191 or 17% were subsequently diagnosed with biopsy-proven or radiological diagnosis of sarcoidosis. Lymphopaenia (<1.5×109/L) was significantly more often observed in patients with sarcoidosis-associated uveitis compared with patients with non-sarcoidosis-associated uveitis (p<0.05). The sensitivity and specificity of lymphopaenia was 75 % and 77 %, respectively. The optimal cut-off for lymphopaenia for diagnosing sarcoidosis-associated uveitis was 1.47 ×109/L. Lymphopaenia resulted in a 12.0 (95% CI 4.7 to 30.5 fold risk for having sarcoidosis, corrected for sex, race and age at onset of uveitis in patients with a first uveitis attack.ConclusionLymphopaenia is a non-invasive and useful marker for diagnosing sarcoidosis-associated uveitis.
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Sève P, Kodjikian L, Jamilloux Y. Manifestations ophtalmologiques de la sarcoïdose : que doit savoir l’interniste ? Rev Med Interne 2018; 39:728-737. [DOI: 10.1016/j.revmed.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
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Takayama K, Harimoto K, Sato T, Sakurai Y, Taguchi M, Kanda T, Takeuchi M. Age-related differences in the clinical features of ocular sarcoidosis. PLoS One 2018; 13:e0202585. [PMID: 30138345 PMCID: PMC6107189 DOI: 10.1371/journal.pone.0202585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/06/2018] [Indexed: 12/05/2022] Open
Abstract
The distribution of age at diagnosis in ocular sarcoidosis has shifted towards the older age groups in developed countries. In systemic sarcoidosis, age-related differences in the clinical presentation, which reflect the therapeutic strategies, was reported. We retrospectively compared 100 consecutive patients from April 2010 to March 2016 who were initially diagnosed with ocular sarcoidosis by International Workshop on Ocular Sarcoidosis criteria. They were classified into elder (>65 years: 50 patients) and younger (≤65 years: 50 patients) groups by the age at diagnosis of uveitis associated with sarcoidosis. All patients received ophthalmic examination to assess the presence of seven intraocular signs and 4 laboratory parameters. Significantly fewer ocular signs (2.8 ± 1.5 and 3.6 ± 1.5; P = 0.0034) and abnormal laboratory results (1.5 ± 1.2 and 2.0 ± 1.2; P = 0.023) were detected in the elder group than in the younger group; statistical differences were found between the groups regarding the frequencies of mutton-fat keratic precipitates (40% and 64%; P = 0.012), vitreous opacities (60% and 78%; P = 0.0059), bilateral inflammation (64% and 80%; P = 0.012), and bilateral hilar lymphadenopathy between the groups (52% and 78%; P < 0.001). Multiple linear regression analysis showed negative correlations between age and number of detected ocular signs (r = −0.36, P < 0.001) and laboratory results (r = −0.20, P = 0.023). The characteristic ocular signs and abnormal laboratory results had a lower frequency in the elder patients compared with the younger patients. Probable or possible ocular sarcoidosis by the international criteria should increase with increased life expectancy in developed countries.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Yutaka Sakurai
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Manzo Taguchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
- * E-mail:
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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.
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Affiliation(s)
- Sungjae Yang
- Department of Ophthalmology, Gangneung Asan Hospital, Ulsan University, Gangneung. Korea
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sherveen Salek
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
- Legacy Devers Eye Institute, 1040 NW 22nd Ave, Suite 200, Portland, OR 97210, USA
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Paovic J, Paovic P, Sredovic V, Jovanovic S. Clinical Manifestations, Complications and Treatment of Ocular Sarcoidosis: Correlation between Visual Efficiency and Macular Edema as Seen on Optical Coherence Tomography. Semin Ophthalmol 2016:1-8. [PMID: 27628176 DOI: 10.1080/08820538.2016.1206576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sarcoidosis is a chronic systemic autoimmune disease which belongs to a group of systemic granulomatous diseases. It can be confirmed through characteristic systemic and ocular manifestations and histological findings. Biopsy is the golden standard for diagnosing sarcoidosis. Ocular sarcoidosis can be confirmed, probable, or possible. Over a two-year period, ocular manifestations were studied on a sample of 52 patients, each followed for four months and diagnosed with some form of systemic sarcoidosis. Most frequent systemic manifestations in patients with ocular sarcoidosis were pulmonary, skin, glandular, and systemic generalized sarcoidosis. The disease was diagnosed four times more frequently in females than males (42:10, respectively; p < 0.05). Most frequent, and statistically significant, manifestation of ocular sarcoidosis is anterior uveitis (64.61%; p < 0.01). Macular edema and periphlebitis associated with periarteritis were frequent, and statistically significant (43.90% and 29.26%, respectively; p < 0.05). Overall, with regards to gender and location (right eye; left eye), visual acuity was >0.5 and of statistical significance (76.92%; p < 0.01). The most common therapy consisted of systemic corticosteroids (26.67%) and/or a combination of corticosteroids and immunosuppressive drugs (23.33%). In 16 eyes treated with repeated doses of sub-Tenon's injections, both initial and control visual acuity correlated with average thickness. There was positive correlation between several optical coherence tomography findings before and after treatment.
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Affiliation(s)
- Jelena Paovic
- a University Eye Clinic , Clinical Center of Serbia , Belgrade , Serbia
| | - Predrag Paovic
- a University Eye Clinic , Clinical Center of Serbia , Belgrade , Serbia
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Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. Ocular sarcoidosis can involve any part of the eye and its adnexal tissues and may cause uveitis, episcleritis/scleritis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and orbital inflammation. Glaucoma and cataract can be complications from inflammation itself or adverse effects from therapy. Ophthalmic manifestations can be isolated or associated with other organ involvement. Patients with ocular sarcoidosis can present with a wide range of clinical presentations and severity. Multidisciplinary approaches are required to achieve the best treatment outcomes for both ocular and systemic manifestations.
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Affiliation(s)
- Sirichai Pasadhika
- Vitreoretinal and Uveitis Service, Legacy Devers Eye Institute, 1040 Northwest 22nd Avenue Suite 168, Portland, OR 97210, USA.
| | - James T Rosenbaum
- Legacy Devers Eye Institute, 1040 Northwest 22nd Avenue Suite 168, Portland, OR 97210, USA
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Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay. Insights Imaging 2016; 7:571-87. [PMID: 27222055 PMCID: PMC4956623 DOI: 10.1007/s13244-016-0495-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis. Teaching Points • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt’s syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.
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Gregory AC, Zhang MM, Rapoport Y, Ling JD, Kuchtey RW. Racial Influences of Uveitic Glaucoma: Consolidation of Current Knowledge of Diagnosis and Treatment. Semin Ophthalmol 2016; 31:400-4. [DOI: 10.3109/08820538.2016.1154169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Judson MA. The three tiers of screening for sarcoidosis organ involvement. Respir Med 2016; 113:42-9. [DOI: 10.1016/j.rmed.2016.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 02/08/2023]
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Ocular Inflammation in the Setting of Concomitant Systemic Autoimmune Conditions in an Older Male Population. Cornea 2016; 34:762-7. [PMID: 26053887 DOI: 10.1097/ico.0000000000000437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This retrospective cross-sectional study was designed to investigate the frequency and types of inflammatory ocular manifestations of specific systemic autoimmune diseases in a South Florida Veterans Affairs Hospital population. METHODS Demographic and medical diagnosis information was extracted from the Veterans Administration database for 1225 patients. These patients were seen in Miami and Broward Veterans Affairs hospitals between April 18, 2008, and April 17, 2013, and were diagnosed with at least 1 of the following: systemic lupus erythematosus, sarcoid, rheumatoid arthritis, polymyalgia rheumatica, Takayasu arteritis, giant cell arteritis, Kawasaki disease, polyarteritis nodosa, Buerger disease, Henoch-Schonlein purpura, Behcet syndrome, granulomatosis with polyangiitis, other polyarteritis nodosa-associated vasculitides, or arteritis not otherwise specified. RESULTS Of 1225 patients, 618 were seen in the VA eye clinic and 25 were diagnosed with concomitant inflammatory ocular conditions. Uveitis was the most common, and included 8 cases of anterior, 1 anterior-intermediate, 1 intermediate, 2 panuveitis, and 3 unspecified. Other manifestations included 7 cases of keratitis and 2 each of scleritis, episcleritis, and acute ischemic optic neuropathy. The overall frequency of inflammatory ocular disease was 2%. The diseases associated with the highest frequency of ocular involvement were granulomatosis with polyangiitis (1/8), sarcoid (9/198), giant cell arteritis (2/68), and rheumatoid arthritis (11/576). Of these 25 patients, 9 were diagnosed with eye disease before systemic disease. CONCLUSIONS In this population, ocular manifestations were rarely the presenting feature of systemic disease, but autoimmune disorders are an important underlying cause of inflammatory eye disease that should be considered on first evaluation, even in this "nontraditional," predominantly male, autoimmune disease population.
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Fakin A, Terčelj M, Vidović Valentinčič N. Frequency of IWOS Suggestive Ocular Signs in Slovenian Uveitis Patients with Confirmed Pulmonary Sarcoidosis. Ocul Immunol Inflamm 2015; 24:660-664. [DOI: 10.3109/09273948.2015.1063669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ana Fakin
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Marjeta Terčelj
- Clinic of Pulmonary Disease and Allergy, University Medical Centre, Ljubljana, Slovenia
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Febvay C, Kodjikian L, Maucort-Boulch D, Perard L, Iwaz J, Jamilloux Y, Broussolle C, Burillon C, Seve P. Clinical features and diagnostic evaluation of 83 biopsy-proven sarcoid uveitis cases. Br J Ophthalmol 2015; 99:1372-6. [DOI: 10.1136/bjophthalmol-2014-306353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/14/2015] [Indexed: 11/04/2022]
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Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and uveitis. Autoimmun Rev 2014; 13:840-9. [DOI: 10.1016/j.autrev.2014.04.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 03/30/2014] [Accepted: 03/30/2014] [Indexed: 12/23/2022]
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Jamilloux Y, Bonnefoy M, Valeyre D, Varron L, Broussolle C, Sève P. Elderly-onset sarcoidosis: prevalence, clinical course, and treatment. Drugs Aging 2014; 30:969-78. [PMID: 24197607 DOI: 10.1007/s40266-013-0125-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sarcoidosis is a systemic disorder of unknown cause characterized by its pathological hallmark, the non-caseating granulomas, and by variable clinical course. While most of the cases affect people aged between 25 and 40 years, approximately 30 % of cases occur in older patients. Elderly-onset sarcoidosis (EOS) is defined as the onset of sarcoidosis in people over 65 years of age. Specific studies on the incidence and prevalence of sarcoidosis in this subgroup are scarce. Several studies suggest that the clinical features of EOS differ from those of sarcoidosis in younger patients. Compared with younger patients, fatigue, uveitis and specific skin lesions are more common, while erythema nodosum and chest x-ray abnormalities are less frequent. The diagnosis of EOS is challenging and may be delayed for many months because of its insidious onset, low prevalence and similarity to other more common disorders. When there is a granulomatous reaction in the elderly, clinicians should doubt the diagnosis and first think of tuberculosis, neoplasia or rare settings such as granulomatosis with polyangiitis or granulomatous reaction due to interferon and tumour necrosis factor-α (TNFα) blockers. A minor salivary gland biopsy also has a higher accuracy for diagnosis in the elderly. The current management of EOS remains empiric because of the lack of randomized, controlled studies. However, the approach to treatment is similar, regardless of the age of the patient. The treatment may be complicated by co-morbidities and increased risk of toxicities from usual treatments, particularly steroids. This review discusses the epidemiology, clinical course, prognosis and treatment of EOS.
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Affiliation(s)
- Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Claude Bernard University Lyon I, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
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Uveitis profile and treatment response in Iranian patients with sarcoidosis. Int Ophthalmol 2014; 35:395-402. [PMID: 24917524 DOI: 10.1007/s10792-014-9960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 05/26/2014] [Indexed: 12/19/2022]
Abstract
The aim of the study was to assess the clinical features and treatment responses in Iranian patients with sarcoid uveitis. A retrospective review of patients diagnosed with sarcoid uveitis from 1996 to 2010 was performed in a referral clinic in Tehran, Iran. Demographic and clinical features of patients, treatment modalities and therapeutic responses, and outcomes were recorded. Sixty-six eyes from 36 patients were studied. Twenty cases had biopsy-proven sarcoidosis. Mean duration of follow-up was 44.7 ± 45 months (range 3-175). Thirty-six eyes (54.5 %) had intermediate uveitis, 25 (37.9 %) panuveitis, and 5 (7.6 %) anterior uveitis. Twenty patients (55.5 %) responded to both systemic and/or topical corticosteroids, and 16 (44.4 %) required immunomodulatory drugs for control of uveitis. All of the patients finally responded to treatment in the form of inflammation reduction and/or vision improvement. The average time interval before initial clinical response following treatment was 3.2 ± 3 months (range 1-72). This study disclosed a higher predominance of females and intermediate form of uveitis in Iranian patients with sarcoid uveitis. Use of immunomodulatory drugs combined with corticosteroids resulted in good visual outcome and control of uveitis with a possible fewer corticosteroid side effects.
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Sarcoidosis: sex-dependent variations in presentation and management. J Ophthalmol 2014; 2014:236905. [PMID: 24987524 PMCID: PMC4060497 DOI: 10.1155/2014/236905] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 05/19/2014] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is an inflammatory disease with a wide range of clinical presentations. The manifestations and prognosis in sarcoidosis are dependent upon not only organ involvement but also age and sex. The purpose of this review is to describe the systemic and ocular manifestations of sarcoidosis with a specific focus on sex-dependent difference in presentation and management. Sarcoidosis is more common in women, particularly in patients who present after age of 50 years. Women with sarcoidosis are more likely to develop cystoid macular edema and the mortality rate is higher than that of men.
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Choudhary MM, Hajj-Ali RA, Lowder CY. Gender and ocular manifestations of connective tissue diseases and systemic vasculitides. J Ophthalmol 2014; 2014:403042. [PMID: 24757559 PMCID: PMC3976932 DOI: 10.1155/2014/403042] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
Ocular manifestations are present in many connective tissue diseases which are characterized by an immune system that is directed against self. In this paper, we review the ocular findings in various connective tissue diseases and systemic vasculitides and highlight gender differences in each disease. In rheumatoid arthritis, we find that dry eyes affect women nine times more than men. The other extra-articular manifestations of rheumatoid arthritis affect women three times more commonly than men. Systemic lupus erythematosus can involve all ocular structures and women are nine times more affected than men. Systemic sclerosis is a rare disease but, again, it is more common in women with a female to male ratio of 8 : 1. Polymyositis and dermatomyositis also affect women more commonly than men but no gender differences have been found in the incidence or disease course in the systemic vasculitides associated with antineutrophil cytoplasmic antibody such as granulomatosis with polyangiitis (GPA, formerly known as Wegener's granulomatosis). Finally, Behcet's disease is more common in males, and male gender is a risk factor for Behcet's disease. There is a slight female preponderance in sarcoidosis with female gender carrying a worse prognosis in the outcome of ocular disease.
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Affiliation(s)
| | - Rula A. Hajj-Ali
- Department of Rheumatology, Cleveland Clinic, 9500 Euclid Avenue, A-50, Cleveland, OH 44195, USA
| | - Careen Y. Lowder
- Cole Eye Institute, 9500 Euclid Avenue, I-10, Cleveland, OH 44195, USA
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