Ocular sarcoidosis in Australia

Abstract

Introduction: Sarcoidosis is an uncommon, but well recognised cause of uveitis in Australia. Making a definitive diagnosis of ocular sarcoidosis is often challenging. The ocular presentation is often the first presentation of the disease, leading to a systemic diagnosis. Ocular sarcoidosis accounts for approximately 5% of patients attending the uveitis unit at Sydney Eye Hospital (SEH). Method(s): We reviewed the real-world data of clinical features, treatment and visual outcomes of patients with sarcoid related uveitis from the SEH uveitis database of more than 2050 patients seen between 2009-2019. Result(s): There were 108 patients (192 eyes) with ocular manifestations consistent of sarcoid. Using the Revised International Diagnostic criteria-32 patients were definite (tissue diagnosis), 37 patients were presumed (abnormal CT chest) and 39 patients were probable sarcoid. The average age was 47 years (range 21-84 years). There were more females than males. Most presentations were bilateral and chronic. The most common presentations were with anterior (38%), intermediate (28%), pan (22%) and posterior (12%) uveitis. The most common complications were cataracts (35 eyes, 18%), 'IOP (33 eyes, 17%), CME (28 eyes, 14%) and optic neuropathy (10 eyes, 5%). Seventy-four (69%) patients received oral prednisone and 39 (36%) had additional immunosuppressive drug therapy. Most patients maintained good vision between 6/6-6/12-75% at presentation and 80% at final review. Conclusion(s): Sarcoid uveitis is common. Patients with ocular sarcoidosis can present with a wide range of clinical manifestations. A multidisciplinary approach is crucial for diagnosis and to achieve the best visual and systemic outcomes.