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Heiligenhaus A, Bertram B, Baquet-Walscheid K, Becker M, Deuter C, Ness T, Ostrowski A, Pleyer U. [Non-infectious anterior uveitis : S1 guideline of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 13.12.2023]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02007-7. [PMID: 38438812 DOI: 10.1007/s00347-024-02007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/06/2024]
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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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Hamma A, Lakhdar Fouatih A. [Choroidal granuloma in miliary tuberculosis; a case report]. J Fr Ophtalmol 2023; 46:e13-e17. [PMID: 36522212 DOI: 10.1016/j.jfo.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Affiliation(s)
- A Hamma
- Service d'ophtalmologie du centre hospitalo-universitaire de Béjaïa et université de Béjaïa, cité des 348 logements bâtiment (D) numéro 3, kiffane, Tlemcen, Algérie.
| | - A Lakhdar Fouatih
- Service d'ophtalmologie du centre hospitalo-universitaire de Béjaïa et université de Béjaïa, cité des 348 logements bâtiment (D) numéro 3, kiffane, Tlemcen, Algérie
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Garneret E, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Trad S, Sève P. Prevalence of Positive QuantiFERON-TB Test among Sarcoid Uveitis Patients and its Clinical Implications in a Country Non-endemic for Tuberculosis. Ocul Immunol Inflamm 2022:1-9. [PMID: 35797278 DOI: 10.1080/09273948.2022.2073238] [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: 10/17/2022]
Abstract
AIM To report on the prevalence and clinical implications of positive QuantiFERON-TB (QFT) test results in the diagnostic evaluation of a cohort of consecutive sarcoid uveitis patients in France. DESIGN Retrospective cross-sectional study. METHODS This study included consecutive sarcoid uveitis patients who all underwent QFT testing. RESULTS A total of 234 patients were included in the study, among them 28 (12%) were QFT-positive. Previously treated tuberculosis (TB) was documented in 2 patients. QFT-positive patients were older (59 ± 16 years vs. 51 ± 18 years, p = .025) and more in proportion to suffer from chronic uveitis and panuveitis compared to QFT-negative patients. Moderate and severe visual impairment were significantly more frequent in the QFT-positive group (35.7% vs. 18.9%, p = .049 and 25.0% vs. 9.2%, p = .022, respectively). CONCLUSION The significant proportion of QFT-positive patients (12%) in this large series of sarcoid uveitis patients makes us suggest not to exclude the diagnosis of sarcoidosis in case of positive QFT in a low-endemic country for tuberculosis, and to manage these patients early by initiating without delay systemic steroids associated with latent tuberculosis therapy.
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Affiliation(s)
- Etienne Garneret
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Université Claude Bernard Lyon 1, Lyon, France.,Department of Ophthalmology, Hôpital de la Croix Rousse, Université Claude Bernard Lyon 1, Lyon, France
| | - Salim Trad
- Department of Internal Medicine, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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