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How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis. Adv Ther 2021; 38:4605-4627. [PMID: 34296400 PMCID: PMC8408061 DOI: 10.1007/s12325-021-01832-5] [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: 03/18/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
Extrapulmonary sarcoidosis occurs in 30–50% of cases of sarcoidosis, most often in association with pulmonary involvement, and virtually any organ can be involved. Its incidence depends according to the organs considered, clinical phenotype, and history of sarcoidosis, but also on epidemiological factors like age, sex, geographic ancestry, and socio-professional factors. The presentation, symptomatology, organ dysfunction, severity, and lethal risk vary from and to patient even at the level of the same organ. The presentation may be specific or not, and its occurrence is at variable times in the history of sarcoidosis from initial to delayed. There are schematically two types of presentation, one when pulmonary sarcoidosis is first discovered, the problem is then to detect extrapulmonary localizations and to assess their link with sarcoidosis, while the other presentation is when extrapulmonary manifestations are indicative of the disease with the need to promptly make the diagnosis of sarcoidosis. To improve diagnosis accuracy, extrapulmonary manifestations need to be known and a medical strategy is warranted to avoid both under- and over-diagnosis. An accurate estimation of impairment and risk linked to extrapulmonary sarcoidosis is essential to offer the best treatment. Most frequent extrapulmonary localizations are skin lesions, arthritis, uveitis, peripheral lymphadenopathy, and hepatic involvement. Potentially severe involvement may stem from the heart, nervous system, kidney, eye and larynx. There is a lack of randomized trials to support recommendations which are often derived from what is known for lung sarcoidosis and from the natural history of the disease at the level of the respective organ. The treatment needs to be holistic and personalized, taking into account not only extrapulmonary localizations but also lung involvement, parasarcoidosis syndrome if any, symptoms, quality of life, medical history, drugs contra-indications, and potential adverse events and patient preferences. The treatment is based on the use of anti-sarcoidosis drugs, on treatments related to organ dysfunction and supportive treatments. Multidisciplinary discussions and referral to sarcoidosis centers of excellence may be helpful for difficult diagnosis and treatment decisions.
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Niederer RL, Ma SP, Wilsher ML, Ali NQ, Sims JL, Tomkins-Netzer O, Lightman SL, Lim LL. Systemic Associations of Sarcoid Uveitis: Correlation With Uveitis Phenotype and Ethnicity. Am J Ophthalmol 2021; 229:169-175. [PMID: 33737030 DOI: 10.1016/j.ajo.2021.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine systemic associations of sarcoid uveitis and association with uveitis clinical phenotype and ethnicity. DESIGN Retrospective cross-sectional study. SUBJECTS A total of 362 subjects with definite or presumed sarcoid uveitis from Moorfields Eye Hospital, Royal Victorian Eye and Ear, and Auckland District Health Board. METHODS Data were collected from the review of clinical notes, imaging, and investigations. Sarcoidosis was diagnosed in accordance with the International Workshop on Ocular Sarcoidosis guidelines. MAIN OUTCOME MEASURE Diagnosis of associated systemic disease secondary to sarcoidosis. RESULTS A total of 362 subjects with sarcoid uveitis were identified. Median age was 46 years, and 226 (62.4%) were female. Granulomatous anterior uveitis (47.8%), intermediate uveitis with snowballs (46.4%), and multifocal choroiditis (43.1%) were the most frequent clinical presentations, and disease was bilateral in 313 (86.5%). Periphlebitis was observed in 21.0%, and solitary optic nerve or choroidal granuloma in 11.3%. Lung parenchymal disease was diagnosed in 200 subjects (55.2%), cutaneous sarcoid in 98 (27.1%), sarcoid arthritis in 57 (15.7%), liver involvement in 21 (5.8%), neurosarcoid in 49 (13.5%), and cardiac sarcoid in 16 subjects (4.4%). Subjects with cardiac sarcoid were less likely to have granulomatous anterior uveitis (P = .017). Caucasian subjects were older at presentation (48 vs 41 years; P = .009), had less granulomatous anterior uveitis (26.4% vs 51.7%; P < .001), and were less likely to present with cutaneous involvement (23.1% vs 35.4%; P = .040). CONCLUSIONS Ophthalmologists need to be aware of the systemic associations of sarcoid uveitis, in particular potentially life-threatening complications such as cardiac sarcoidosis. Differences observed in uveitis phenotype and between ethnicities require further investigation.
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Affiliation(s)
- Rachael Louise Niederer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.).
| | - Shirley P Ma
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Margaret L Wilsher
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Noor Q Ali
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Joanne L Sims
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Oren Tomkins-Netzer
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Sue L Lightman
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
| | - Lyndell L Lim
- From the Department of Ophthalmology, Auckland District Health Board (R.L.N., J.L.S.); Department of Ophthalmology, University of Auckland (R.L.N.), Auckland, New Zealand; Royal Victoria Eye and Ear, Melbourne, Australia (S.P.M., L.L.L.); Respiratory Services, Auckland District Health Board (M.L.W.); Faculty of Medical and Health Sciences, University of Auckland (M.L.W.), Auckland, New Zealand; Sydney Eye Hospital, Sydney, Australia (N.Q.A.); Department of Ophthalmology, Carmel Medical Centre, Technion, Haifa, Israel (O.T.-N.); University College London, London, United Kingdom (S.L.L.); and Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (L.L.L.)
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103
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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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104
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Kindt A, Byg KE, Wied J, Ellingsen T, Davidsen JR, Grauslund J. Altered retinal oxygen metabolism in patients with combined ocular and central nervous system sarcoidosis. Rheumatology (Oxford) 2021; 60:3301-3306. [PMID: 33313874 DOI: 10.1093/rheumatology/keaa781] [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: 07/30/2020] [Revised: 10/08/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate retinal oxygen metabolism by retinal oximetry for ocular and CNS diseases in a cross-sectional study of sarcoidosis. METHODS Overall 201 eyes from 103 biopsy-verified sarcoidosis patients were included and divided into four groups depending on the organ affection: (i) sarcoidosis without ocular or CNS affection, (ii) ocular sarcoidosis, (iii) CNS sarcoidosis, and (iv) combined ocular and CNS sarcoidosis. Retinal oximetry was obtained and analysed, with the mean retinal arteriolar and venular saturation as well as arteriovenous difference as principal outcomes. Comparison between groups was done in a multi linear regression model adjusted for age, sex, duration of sarcoidosis, best corrected visual acuity and retinal oximetry quality. RESULTS Mean (s.d.) age was 50.5 (13.4) (95% CI: 47.9, 53.1) years and 52.2% were males. Eyes of the combined Ocular/CNS group had a higher retinal arteriovenous difference than eyes of the Non-ocular/no-CNS group (42.1% vs 37.7%, P = 0.012) but did not differ between other groups. Eyes in the four groups (Non-ocular/no-CNS, Ocular, CNS and Ocular/CNS) did not differ according to retinal arterial (94.5%, 93.5%, 93.5% and 94.5%, respectively) or venular (57.5%, 56.4%, 55.0% and 52.5%, respectively) oxygen saturation. CONCLUSIONS The results of this study suggest that eyes of sarcoidosis patients with combined ocular and CNS affection have an altered oxygen metabolism indicating a subclinical eye affection that is not recognized by conventional screening methods.
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Affiliation(s)
- Astrid Kindt
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Keld-Erik Byg
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark.,Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | - Jimmi Wied
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Rheumatology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- South Danish Center for Interstitial Lung Diseases, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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105
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Powell MS, Cross AW, Tallo J, Cheeseman EW, Gilbert MR. Sarcoidosis presenting as bilateral lacrimal gland swelling: a pediatric case report. Pediatr Rheumatol Online J 2021; 19:117. [PMID: 34362395 PMCID: PMC8348864 DOI: 10.1186/s12969-021-00606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To describe a case of pediatric sarcoidosis which initially presented as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without other known systemic involvement. CASE PRESENTATION A 10-year-old female presented to the pediatric ophthalmology clinic with complaints of bilateral eyelid swelling, tearing and itching for approximately 1 month. Her history and exam were most consistent with allergic conjunctivitis, for which she was started on a standard topical regimen. Despite initial improvement, she re-presented with significantly worsened eyelid swelling and minimal allergic symptoms. Enlargement of the lacrimal glands were palpable at this time. Lacrimal gland biopsy was obtained which demonstrated noncaseating granulomas. Systemic workup did not reveal evidence of disease involvement elsewhere. CONCLUSIONS Sarcoidosis in the pediatric population may present in a myriad of ways and is well-known to mimic other disease entities. We present a case of pediatric sarcoidosis which presented initially as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without systemic involvement.
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Affiliation(s)
- Margaret S. Powell
- grid.28803.310000 0001 0701 8607Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, WI USA
| | - Ashley W. Cross
- grid.259828.c0000 0001 2189 3475Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Jared Tallo
- grid.259828.c0000 0001 2189 3475College of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Edward W. Cheeseman
- grid.259828.c0000 0001 2189 3475Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC USA
| | - Mileka R. Gilbert
- grid.259828.c0000 0001 2189 3475Division of Pediatric Rheumatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA
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106
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Van Gelder RN, Sen HN, Tufail A, Lee AY. Here Comes the SUN (Part 2): Standardization of Uveitis Nomenclature for Disease Classification Criteria. Am J Ophthalmol 2021; 228:A2-A6. [PMID: 33992617 DOI: 10.1016/j.ajo.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Russell N Van Gelder
- Department of Ophthalmology, University of Washington School of Medicine; Departments of Biological Structure and Laboratory Medicine and Pathology, University of Washington School of Medicine; Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine.
| | - H Nida Sen
- National Eye Institute, U.S. National Institutes of Health; Department of Ophthalmology, George Washington University, Washington, DC; Jannsen Pharaceuticals, Raritan, NJ
| | - Adnan Tufail
- Department of Ophthalmology, University College, London, UK; Medical Retina Service, Moorfields Eye Hospital, London, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington School of Medicine; Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine
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107
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Bert A, Gilbert T, Cottin V, Mercier J, Gerfaud-Valentin M, Durieu I, Hot A, Hicks J, Varron L, Seve P, Jamilloux Y. Sarcoidosis diagnosed in the elderly: a case-control study. QJM 2021; 114:238-245. [PMID: 32569362 DOI: 10.1093/qjmed/hcaa171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 04/18/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies on sarcoidosis in elderly patients are scarce and none have specifically evaluated patients aged ≥75 at onset. AIM We aimed to analyse the characteristics of patients with sarcoidosis diagnosed after 75 and to compare them with those of younger patients. DESIGN Multicenter case-control study comparing elderly-onset sarcoidosis (EOS) with young-onset sarcoidosis (YOS) seen at Lyon University Hospitals between 2006 and 2018. METHODS Using our institutional database, we included 34 patients in the EOS group and compared them with 102 controls from the YOS group in a 1:3 ratio. Demographic characteristics, medical history, clinical presentation, laboratory and imaging findings, sites of biopsies, histological analyses, treatments and outcomes were recorded using a comprehensive questionnaire. RESULTS There were more Caucasians in the EOS group (94.1% vs. 59.8%; P < 0.001), who had significantly more comorbidities (mean, 3.1 ± 2 vs. 1.1 ± 1.6; P < 0.001). In the EOS group, there was less pulmonary involvement (26.5% vs. 49%; P = 0.022), less lymphadenopathy (2.9% vs. 16.7%; P = 0.041), no erythema nodosum (0% vs. 12.8%; P = 0.029) and no arthralgia (0% vs. 25.5%; P = 0.001). Conversely, uveitis was more common in the EOS group (55.9% vs. 20.6%; P < 0.001). Pathological confirmation was obtained significantly less frequently in the EOS group (67.7% vs. 85.3%; P = 0.023). Corticosteroid-related side effects were significantly more common in the EOS group (100% vs. 75.9%; P = 0.030). CONCLUSION Epidemiology and clinical presentation of EOS differs from YOS, including more comorbidities and more uveitis. Elderly patients are more prone to corticosteroid side effects.
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Affiliation(s)
- A Bert
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - T Gilbert
- Short Stay Geriatric Unit, Lyon Sud University Hospital, University Claude Bernard University Lyon 1, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - V Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel University Hospital, University Claude Bernard University Lyon 1, 59 Boulevard Pinel, 69500 Bron, France
| | - J Mercier
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - M Gerfaud-Valentin
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - I Durieu
- Department of Internal Medicine, Lyon Sud University Hospital, University Claude Bernard University Lyon 1, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - A Hot
- Department of Internal Medicine, Edouard Herriot University Hospital, University Claude Bernard University Lyon 1, 5 Place d'Arsonval, 69003 Lyon, France
| | - J Hicks
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - L Varron
- Department of Internal Medicine, Montélimar Hospital, Quartier Beausseret, Route de Sauzet, 26200 Montélimar, France
| | - P Seve
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Y Jamilloux
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude Bernard University Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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Rodrigues FG, Petrushkin H, Webster AR, Bickerstaff M, Moraitis E, Rowczenio D, Aróstegui JI, Westcott M. A Novel Pathogenic NOD2 Variant in a Mother and Daughter with Blau Syndrome. Ophthalmic Genet 2021; 42:753-764. [PMID: 34251956 DOI: 10.1080/13816810.2021.1946701] [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: 10/20/2022]
Abstract
BACKGROUND Blau syndrome (BS) is a rare dominantly-inherited autoinflammatory disorder characterized by the triad of arthritis, uveitis and dermatitis that is consequence of gain-of-function NOD2 mutations. We describe the clinical features and genetic basis of a family with two affected members in consecutive generations affected with childhood onset arthritis and uveitis. MATERIALS AND METHODS Clinical features were retrospectively collected from clinical records. Genetic studies were performed using the Sanger method of DNA sequencing. RESULTS The proband is a 44 years-old female, who was diagnosed with juvenile onset arthritis at the age of 9 years. She subsequently developed uveitis at age 12 and since then she was managed between the uveitis and rheumatology services. The proband's daughter developed episcleritis at the age of 7 years, and arthritis with bilateral intermediate uveitis two years later. NOD2 analyses revealed in both patients the heterozygous c.1494A>C transversion, predicted to lead the novel, missense p.E498D variant in the NOD2 protein. Additional studies including databases searches and in silico bioinformatic predictions strongly support the "likely pathogenic" classification for this novel variant. CONCLUSIONS We report a novel pathogenic NOD2 variant in a multiplex family with clinical features compatible with the BS diagnosis. This condition is inherited as a dominant trait in its familial form and should be considered in patients with granulomatous uveitis in association with arthritis and/or dermatitis. Further insight into NOD2 variants and their downstream effects may have implications in the treatment of BS and other inflammatory granulomatous diseases.
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Affiliation(s)
- Filipa G Rodrigues
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Harry Petrushkin
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Rheumatology Department, Great Ormond Street Hospital for Children, London, UK
| | - Andrew R Webster
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,UCL Institute of Ophthalmology, London, UK.,Genetics Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Elena Moraitis
- Rheumatology Department, Great Ormond Street Hospital for Children, London, UK
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, London, UK
| | - Juan I Aróstegui
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,School of Medicine, Universitat De Barcelona, Barcelona, Spain
| | - Mark Westcott
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
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Abstract
Sarcoidosis is a chronic inflammatory disease of unknown etiology that affects many systemic organs, including the eye. The eye is the second most frequently affected organ in patients with sarcoidosis after lung disease. Approximately 30-50% of patients with systemic sarcoidosis develop uveitis, which is a sight-threatening intraocular inflammatory disorder. Sarcoidosis is the leading cause of uveitis in Japan and is one of the major clinical entities in many countries. Therefore, uveitis in association with sarcoidosis (ocular sarcoidosis) is considered essential in clinical practice in ophthalmology. The current review focuses on distinguishing features of ocular sarcoidosis, diagnosis, management, and discussion of the etiology of ocular sarcoidosis.
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Affiliation(s)
- Hiroshi Takase
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, Gordon DL, Smith JR. Ocular syphilis. Surv Ophthalmol 2021; 67:440-462. [PMID: 34147542 DOI: 10.1016/j.survophthal.2021.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
Multiple studies around the world suggest that syphilis is re-emerging. Ocular syphilis - with a wide range of presentations, most of which are subtypes of uveitis - has become an increasingly common cause of ocular inflammation over the past 20 years. Its rising incidence, diagnostic complexity, and manifestations that have only recently been characterized make ocular syphilis relevant from the public health, clinical, and scientific perspectives. We review the demographics, epidemiology, clinical features, ocular imaging findings, diagnosis, and medical management of this condition.
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Affiliation(s)
- João M Furtado
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Milena Simões
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Daniel Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Mudit Tyagi
- Ocular Inflammation and Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Heloisa Nascimento
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia-IPEPO, São Paulo, Brazil
| | - David L Gordon
- Flinders University College of Medicine and Public Health, Adelaide, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, South Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
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Shirahama S, Taniue K, Mitsutomi S, Tanaka R, Kaburaki T, Sato T, Takeuchi M, Kawashima H, Urade Y, Aihara M, Akimitsu N. Human U90926 orthologous long non-coding RNA as a novel biomarker for visual prognosis in herpes simplex virus type-1 induced acute retinal necrosis. Sci Rep 2021; 11:12164. [PMID: 34108530 PMCID: PMC8190147 DOI: 10.1038/s41598-021-91340-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 11/08/2022] Open
Abstract
Acute retinal necrosis (ARN) is a form of infectious uveitis caused by alpha herpesviruses, including herpes simplex virus type 1 (HSV-1). We previously found that the long non-coding RNA (lncRNA) U90926 is upregulated in murine retinal photoreceptor cells following HSV-1 infection, leading to host cell death. However, to date, an orthologous transcript has not been identified in humans. We investigated U90926 orthologous transcript in humans and examined its utility as a prognostic marker for visual acuity in patients with ARN. We identified two human orthologous transcripts (1955 and 592 bases) of lncRNA U90926. The amount of the longer human U90926 transcript was approximately 30- and 40-fold higher in the vitreous fluid of patients with ARN than in those with sarcoidosis and intraocular lymphoma, respectively. Furthermore, the expression of the longer human U90926 transcript in the vitreous fluid was highly correlated with the final best-corrected logarithm of the minimum angle of resolution visual acuity in patients with ARN (r = 0.7671, p = 0.0079). This suggests higher expression of the longer human U90926 transcript in the vitreous fluid results in worse visual prognosis; therefore, expression of the longer human U90926 transcript is a potential negative prognostic marker for visual acuity in patients with ARN.
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Affiliation(s)
- Shintaro Shirahama
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenzui Taniue
- Isotope Science Center, The University of Tokyo, Tokyo, Japan
| | | | - Rie Tanaka
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Jichi Medical University Saitama Medical Centre, Saitama, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | | | - Yoshihiro Urade
- Isotope Science Center, The University of Tokyo, Tokyo, Japan
- Daiichi University of Pharmacy, Fukuoka, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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112
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Agarwal A, Aggarwal K, Pichi F, Meng T, Munk MR, Bazgain K, Bansal R, Agrawal R, Gupta V. Clinical and Multimodal Imaging Clues in Differentiating Between Tuberculomas and Sarcoid Choroidal Granulomas. Am J Ophthalmol 2021; 226:42-55. [PMID: 33529591 DOI: 10.1016/j.ajo.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the differences among clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis. DESIGN Retrospective comparative case series. METHODS Clinical features and fundus imaging, including fluorescein and indocyanine green angiography and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at 3 tertiary care centers, were reviewed. The differences among clinical appearances, including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features, were compared. Repeated logistic regression measurements with a multilevel random effects model was used to assess characteristics of individual granulomas that could predict the underlying cause. RESULTS The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculomas were significantly younger (33.8 ± 10.1 vs. 48.6 ± 14.3 years, respectively; P = .002), but no sex differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (P <.001), intense yellow, lobulated, full thickness, and located in the perivascular region (all P <.001); they were also larger (16.01 ± 9.7 mm2 vs. 2.7 ± 4.5 mm2, respectively; P <.001) and were vascularized (P <.001). Sarcoid granulomas were associated with retinal vasculitis (P = .003) and disc hyperfluorescence (P <.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio [OR]: 3.5; 95% confidence interval: 1.8-6.9; P <.001). Granulomas larger than 6.45 mm2 had the highest area under the receiver operating curves (0.94) for differentiating tuberculomas from sarcoid granulomas. CONCLUSIONS Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate between the 2 entities with high predictability and can supplement immunological and radiological tests in a diagnosis.
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113
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Suzuki T, Kaburaki T, Tanaka R, Shirahama S, Komae K, Nakahara H, Takamoto M, Kawashima H, Aihara M. Incidence and changing patterns of uveitis in Central Tokyo. Int Ophthalmol 2021; 41:2377-2388. [PMID: 34047908 DOI: 10.1007/s10792-021-01791-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The patterns of uveitis in Tokyo have recently changed due to advances in examination tools. We aimed to investigate the changes in the patterns of uveitis between 2004-2015 and 2016-2018. METHODS We retrospectively reviewed the data of 732 patients who visited the Uveitis Clinic at the University of Tokyo Hospital between January 2016 and December 2018. Background characteristics, laboratory results, and imaging findings were analysed. We compared the incidences of uveitis in 2016-2018 and 2004-2015 to identify changes in the patterns. RESULTS The most frequent diagnoses were sarcoidosis (8.9%), herpetic iridocyclitis (6.7%), intraocular lymphoma (5.5%), Vogt-Koyanagi-Harada disease (4.8%), unclassified acute anterior uveitis (4.6%), Behçet's disease (4.5%), bacterial endophthalmitis (2.9%), and Posner-Schlossman syndrome (2.6%). Suspected sarcoidosis (20.9%) was the most common cause of unclassified uveitis. The incidence of intraocular lymphoma was significantly higher in 2016-2018 than in 2004-2015. Between 2004 and 2018, herpetic iridocyclitis, bacterial endophthalmitis, and juvenile chronic iridocyclitis exhibited an increasing trend, and the incidences of Posner-Schlossman syndrome, unclassified acute anterior uveitis, Behçet's disease, and Vogt-Koyanagi-Harada disease exhibited a decreasing trend. CONCLUSION The changing patterns of uveitis were characterised by increases in the incidence of intraocular lymphoma. This may be attributed to recent advances in examination tools, the changes in the referred patient population, and the aging Japanese population.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Ophthalmology, Shinseikai Toyama Hospital, Toyama, 939-0243, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Ophthalmology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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114
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Wei YH, Tian T, Zhu RL, Li M. Glaucoma secondary to trabecular meshwork precipitates: a case report of Grant's syndrome. Int J Ophthalmol 2021; 14:780-782. [PMID: 34012897 DOI: 10.18240/ijo.2021.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ya-Hui Wei
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Tian Tian
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Rui-Lin Zhu
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Mei Li
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
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115
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Berkowitz ST, Brock AL, Reichstein DA. Chorioretinal Biopsy-Proven Ocular Sarcoidosis in a Patient with a History of B-Cell Lymphoma. Case Rep Ophthalmol 2021; 12:438-445. [PMID: 34054498 PMCID: PMC8136327 DOI: 10.1159/000512694] [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: 10/06/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of this report is to describe biopsy-proven ocular sarcoidosis (OS) in a 67-year-old patient with a history of sarcoidosis and diffuse large B-cell lymphoma (DLBCL). Nonspecific posterior chorioretinal lesions in a patient with prior malignancy necessitated chorioretinal biopsy to rule out metastatic lymphoma. The association between sarcoidosis and malignancy remains unclear and can complicate management of similar patients with nonspecific posterior segment findings. Chorioretinal biopsy may, therefore, be required to rule out malignancy in patients with a leading history.
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Affiliation(s)
- Sean T Berkowitz
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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116
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Oh DJ, Singh A, Kanu LN, Lobo-Chan AM, MacIntosh PW, Bhat P. Outcomes of Repository Corticotropin Gel for Ocular Sarcoidosis. Ocul Immunol Inflamm 2021; 30:1420-1424. [PMID: 33826473 DOI: 10.1080/09273948.2021.1884887] [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] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluate the utility and side effect profile of subcutaneous repository corticotropin gel (RCI) in ocular sarcoidosis.Methods: Retrospective chart review.Results: Among six identified patients on RCI therapy, 4 had uveitis, one had optic neuritis and one had uveitis and optic neuritis secondary to sarcoidosis. The average follow-up was 43.5 months. RCI therapy was continuous in 4 patients (average 7.7 months) and intermittent in 2 patients (24 and 12 months). Five of the 6 patients continued with local and/or systemic corticosteroids for ocular inflammation control while on RCI therapy. Two-thirds of patients experienced adverse effects including hyperpigmentation, alopecia, and severe hypertension. RCI therapy was discontinued in 5 of the 6 patients due to continued inflammation and side/adverse effects (4 patients) and loss of follow-up (1 patient).Conclusion: In this small cohort, the majority of patients failed to achieve adequate steroid-sparing ocular inflammation control and experienced side effects while on RCI therapy. Additional studies are needed to elucidate the role of RCI in ocular inflammation.
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Affiliation(s)
- Daniel J Oh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.,Columbia University Irving Medical Center, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York, USA.,Vitreous, Retina, Macula Consultants of New York, New York, New York, USA
| | - Arjun Singh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Levi N Kanu
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Peter W MacIntosh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pooja Bhat
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
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Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, Boussel L, Calender A, Androdias G, Valeyre D, El Jammal T. Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis. Cells 2021; 10:cells10040766. [PMID: 33807303 PMCID: PMC8066110 DOI: 10.3390/cells10040766] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25-50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren's syndrome, lupus pernio, Heerfordt's syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, 69007 Lyon, France
- Correspondence:
| | - Yves Pacheco
- Faculty of Medicine, University Claude Bernard Lyon 1, F-69007 Lyon, France;
| | - François Durupt
- Department of Dermatology, Lyon University Hospital, 69004 Lyon, France;
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Sylvie Isaac
- Department of Pathology, Lyon University Hospital, 69310 Pierre Bénite, France;
| | - Loïc Boussel
- Department of Radiology, Lyon University Hospital, 69004 Lyon, France
| | - Alain Calender
- Department of Genetics, Lyon University Hospital, 69500 Bron, France;
| | - Géraldine Androdias
- Department of Neurology, Service Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon University Hospital, F-69677 Bron, France;
| | - Dominique Valeyre
- Department of Pneumology, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne et Université Paris 13, Sorbonne Paris Cité, 93008 Bobigny, France;
| | - Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
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118
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Asakage M, Usui Y, Nezu N, Shimizu H, Tsubota K, Yamakawa N, Takanashi M, Kuroda M, Goto H. Comprehensive miRNA Analysis Using Serum From Patients With Noninfectious Uveitis. Invest Ophthalmol Vis Sci 2021; 61:4. [PMID: 32876691 PMCID: PMC7476662 DOI: 10.1167/iovs.61.11.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose MicroRNAs (miRNAs) are noncoding RNAs and have attracted attention as a biomarker in a variety of diseases. However, extensive unbiased miRNAs analysis in patients with uveitis has not been completely explored. In the present study, we comprehensively analyzed the deregulated miRNAs in three major forms of uveitis (Behҫet's disease [BD], sarcoidosis and Vogt–Koyanagi–Harada disease [VKH]) to search for potential biomarkers. Methods This study included 10 patients with BD, 17 patients with sarcoidosis, and 13 patients with VKH. Eleven healthy subjects were used as controls. The miRNAs expression levels were studied by microarray using serum samples from patients with uveitis and healthy controls. Results A total of 281 upregulated miRNAs and 137 downregulated miRNAs were detected in patients with BD, 35 upregulated miRNAs and 86 downregulated miRNAs in patients with sarcoidosis, and 153 upregulated miRNAs and 35 downregulated miRNAs in patients with VKH. Some deregulated miRNAs were involved in the mitogen-activated protein kinase signaling pathway and inflammatory cytokine pathways. Furthermore, we identified miR-4708-3p, miR-4323, and let-7g-3p as the best predictor miRNAs for BD, sarcoidosis, and VKH, respectively. Panels of miRNAs with diagnostic potential for the three diseases were generated using machine learning. Conclusions In this study, comprehensive miRNA analysis identified deregulated miRNAs in three major forms of noninfectious uveitis. This study provides new insights into molecular pathogenetic mechanisms and useful information toward developing novel diagnostic biomarkers and therapeutic targets for BD, sarcoidosis, and VKH.
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Affiliation(s)
- Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoyuki Yamakawa
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masakatsu Takanashi
- Department of Molecular pathology Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular pathology Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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119
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Papasavvas I, Gehrig B, Herbort CP. The Comparative Value of Serum Angiotensin Converting Enzyme (ACE) and Lysozyme and the Use of Polyclonal Antibody Activation in the Work-up of Ocular Sarcoidosis. Diagnostics (Basel) 2021; 11:diagnostics11040608. [PMID: 33805490 PMCID: PMC8066732 DOI: 10.3390/diagnostics11040608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The diagnosis of ocular sarcoidosis (OS) is difficult to establish in the absence of manifest systemic involvement. To help clinicians reach a diagnosis, we convened a group of experts in 2006 (International Workshop on Ocular Sarcoidosis (IWOS)) to set-up clinical criteria for the diagnosis of ocular sarcoidosis. In addition, laboratory investigational tests represent a much-needed adjunct to ascertain the diagnosis. However, many of these tests have low sensitivity and specificity. Purpose: The aim of our study was to evaluate the usefulness of serum ACE, serum lysozyme and polyclonal antibody activation in the diagnosis of ocular sarcoidosis and compare the frequency of increased serum levels of lysozyme and ACE in proven ocular sarcoidosis or in suspected ocular sarcoidosis. Methods: Serum ACE and lysozyme were assessed in these two groups and their means compared to a group of non-granulomatous (i.e., non-sarcoidosis) uveitis patients. The proportion of elevated serum ACE versus lysozyme was compared in the sarcoidosis patients. Polyclonal antibody activation was measured by establishing exposition of patients to four human commensal herpesviruses (EBV, CMV, HSV and VZV) using ELISA or immunofluorescence and in parallel by performing quantitative complement fixation (CF) serologies. The ratio of elevated CF to positive ELISA/immunofluorescence serologies was calculated. The mean of ratios (polyclonal antibody activation) was compared between ocular sarcoidosis and control groups. Results: Thirty-seven patients (F24/M13) were included in our study including 17 patients with IWOS Level 1 and 2 criteria qualifying for Group 1 (proven sarcoidosis) and 20 ocular sarcoidosis suspect patients. Mean age was 54.52 ± 23.74. Mean serum levels of ACE was 49.17± 29 IU/L in the ocular sarcoidosis group versus 27.4 ± 15.34 IU/L (p ≤ 0.00018, student’s t test) in the control group. Mean serum lysozyme levels was 39.92 ± 55.5 mg/L in the ocular sarcoidosis group versus 10.5 ± 5.8 mg/L (p ≤ 0.0013) in the control group (n = 30). Both tests were elevated in 8/37 (21.6%) patients, elevated ACE and normal lysozyme was noted in 2/37 (5.4%) patients, whereas the proportion of normal ACE/elevated lysozyme was much higher, 23/37 (62.2%). In 4/37 (10.8%) patients, both tests were normal. The mean score of polyclonal activation (N of elevated CF serologies divided by number of viruses to which a patient was exposed) was 0.6 ± 0.33 in the ocular sarcoidosis group versus 0.15 ± 0.2 for the control group (n = 42) (p ≤ 0.00001). Sensitivity and specificity of ACE and lysozyme were, respectively, 27%/96.6% and 83.7%/90%. Sensitivity and specificity of polyclonal antibody activation amounted to 70%/90.4% Conclusion: Lysozyme was found to be much more useful than ACE as a laboratory test to support the diagnosis of ocular sarcoidosis. As shown in a previous study, polyclonal antibody activation appears to be another useful laboratory test supportive of the diagnosis of ocular sarcoidosis.
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120
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Khalsa A, Kelgaonkar A, Padhy SK, Agarwal T, Patel A, Behera UC, Basu S. Posterior Subhyaloid Precipitates: 'KPs' of the Posterior Segment. Semin Ophthalmol 2021; 36:751-756. [PMID: 33734863 DOI: 10.1080/08820538.2021.1900291] [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] [Indexed: 10/21/2022]
Abstract
Purpose: To describe the course of posterior subhyaloid precipitates (PSPs) accompanying active retinitis. Methods: Retrospective study of three retinitis cases associated with PSPs and literature review. Results: Cases 1 and 2 were Toxoplasma retinochoroiditis. Case 3 had bilateral retinitis post-febrile illness. PSPs were yellowish-white spherical lesions seen in the presence of partial posterior hyaloid detachment (PVD) in the retro-hyaloid space lining the inferior PVD margin. In all 3 cases, PSPs resolved during treatment for primary disease. Resolution of PSPs preceded resolution of retinitis. Literature review revealed similar lesions in CMV retinitis and syphilis in addition to Toxoplasma retinochoroiditis. Conclusion: PSPs were seen in the presence of active retinitis and partial PVD when inflammatory aggregates gravitate inferiorly in the subhyaloid space. They were observed during active retinitis and their resolution preceded the resolution of retinitis, thus providing a potential marker for disease resolution.
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Affiliation(s)
- Ashish Khalsa
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Srikanta Kumar Padhy
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Tushar Agarwal
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Anamika Patel
- Retina and uveitis services, LV Prasad Eye Institute, GMR Varalaxmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Umesh Chandra Behera
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Soumyava Basu
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
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Sonoda KH, Hasegawa E, Namba K, Okada AA, Ohguro N, Goto H. Epidemiology of uveitis in Japan: a 2016 retrospective nationwide survey. Jpn J Ophthalmol 2021; 65:184-190. [PMID: 33694024 DOI: 10.1007/s10384-020-00809-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the epidemiology of uveitis in Japan and assess its changes over time. STUDY DESIGN Retrospective multicenter study METHODS: Sixty-six hospitals in Japan with uveitis specialty clinics participated in this retrospective nationwide survey. A questionnaire was sent to each hospital to survey the total number of patients who made a first visit to the outpatient uveitis clinic of each hospital between 1 April 2016 and 31 March 2017. The diagnosis of uveitis was based on guidelines when available or on commonly used diagnostic criteria. RESULTS In 2016, new patients with uveitis accounted for 3.2% of the total number of new patients with ophthalmic diseases. A total of 5378 patients were enrolled in the survey; 3408 cases could be classified with a specific uveitis entity, and 1970 cases were described as unclassified intraocular inflammation. Among the classified cases, the most frequent disease was sarcoidosis (10.6%), followed by Vogt-Koyanagi-Harada disease (8.1%), herpetic iritis (6.5%), acute anterior uveitis (5.5%), sclerouveitis (4.4%), Behçet's disease (4.2%), malignant disease (2.6%), acute retinal necrosis (1.7%), Posner-Schlossman syndrome (1.7%), and diabetic iritis (1.4%). The rates of sarcoidosis, Vogt-Koyanagi-Harada disease, and Behçet's disease were similar; however, the rate of herpes iritis increased (4.2-6.5%) when compared with the 2009 survey. CONCLUSIONS Some changes were observed between the previous nationwide surveys (2002 and 2009) and the present survey. It must be valuable to continue such nationwide epidemiologic surveys at regular intervals.
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Affiliation(s)
- Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Eiichi Hasegawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Nobuyuki Ohguro
- Japan Community Health Care Organization Hospital, Osaka, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan
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Pichi F, Smith SD, Neri P, Woodstock E, Hay S, Parrulli S, Corvi F, Mapelli C, Invernizzi A. CHOROIDAL GRANULOMAS VISUALIZED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2021; 41:602-609. [PMID: 32467485 DOI: 10.1097/iae.0000000000002864] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the visualization of choroidal granulomas with swept-source optical coherence tomography angiography (OCTA). METHODS Consecutive patients with granulomatous choroiditis due to tuberculosis, sarcoidosis, or Vogt-Koyanagi-Harada disease underwent baseline OCTA images using a 12 × 12-mm field of view, and the choroidal slabs were analyzed by two independent examiners who counted the oval areas of flow void. Simultaneously, indocyanine green angiography (ICGA) and enhanced-depth imaging OCT were performed to mark visible choroidal changes corresponding to granulomatous lesions. The lesion areas on OCTA and ICGA were assessed using the in-built caliper tool. RESULTS Three hundred and one round-shaped areas of flow void on OCTA, 209 hypofluorescent round lesions on ICGA, and 42 hyporeflective choroidal lesions on enhanced-depth imaging OCT were identified in 23 eyes from 14 patients. Of the 209 ICGA granulomas, 197 (94.3%) had a corresponding round area of flow void on OCTA that was interpreted as a granuloma. One hundred and four additional round flow voids were identified on OCTA that did not correspond to any hypofluorescent lesion on ICGA. The mean area of the 197 granulomas detected with both imaging modalities was significantly larger on ICGA (mean 0.33 mm2) than that on OCTA (mean 0.28 mm2). CONCLUSION Optical coherence tomography angiography seems to be an optimal imaging method for the visualization of choroidal granulomas.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Scott D Smith
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Steven Hay
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Chiara Mapelli
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Grande Foundation-Ospedale Maggiore Policlinico, Milan, Italy ; and
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
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123
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Conti MLD, Osaki MH, Sant'Anna AE, Osaki TH. Orbitopalpebral and ocular sarcoidosis: what does the ophthalmologist need to know. Br J Ophthalmol 2021; 106:156-164. [PMID: 33622698 DOI: 10.1136/bjophthalmol-2020-317423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022]
Abstract
Sarcoidosis is a chronic multisystemic disease of unknown aetiology, characterised by non-caseating granulomas. Ocular involvement rate ranges from 30% to 60% among individuals with sarcoidosis, and can vary widely, making the diagnosis a challenge to the ophthalmologist. Cutaneous manifestations occur in about 22% of sarcoidosis cases, but eyelid involvement is rare. Eyelid swelling and nodules are the most frequent forms of eyelid involvement, but other findings have been reported. The joint analysis of clinical history, ancillary exams and compatible biopsy is needed for the diagnosis, as well as the exclusion of other possible conditions. This review aims to describe the different forms of presentations, the clinical reasoning and treatment options for ocular, eyelid and orbital sarcoidosis.
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Affiliation(s)
- Marina Lourenço De Conti
- Department of Ophthalmology and Visual Sciences, Division of Ophthalmic Plastic and Reconstructive Surgery, Paulista School of Medicine / Federal University of S. Paulo - EPM / UNIFESP, S. Paulo, SP, Brazil
| | - Midori Hentona Osaki
- Department of Ophthalmology and Visual Sciences, Division of Ophthalmic Plastic and Reconstructive Surgery, Paulista School of Medicine / Federal University of S. Paulo - EPM / UNIFESP, S. Paulo, SP, Brazil.,Ophthalmology, Osaki Ophthalmology, S. Paulo, SP, Brazil
| | - Ana Estela Sant'Anna
- Department of Ophthalmology and Visual Sciences, Division of Ophthalmic Plastic and Reconstructive Surgery, Paulista School of Medicine / Federal University of S. Paulo - EPM / UNIFESP, S. Paulo, SP, Brazil
| | - Tammy Hentona Osaki
- Department of Ophthalmology and Visual Sciences, Division of Ophthalmic Plastic and Reconstructive Surgery, Paulista School of Medicine / Federal University of S. Paulo - EPM / UNIFESP, S. Paulo, SP, Brazil .,Ophthalmology, Osaki Ophthalmology, S. Paulo, SP, Brazil
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Conti ML, Osaki MH, Sant'Anna AE, Osaki TH. Multiple Faces of Eyelid Involvement in Sarcoidosis. Ocul Immunol Inflamm 2021; 30:925-929. [PMID: 33606589 DOI: 10.1080/09273948.2020.1853782] [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: 10/22/2022]
Abstract
Purpose: To report three cases of eyelid involvement by sarcoidosis. In one of them, it mimicked a malignant lesion.Methods: Retrospective case reports.Results: A 73-year-old man presented with destruction of the left lower eyelid for 2 years. He had granulomatous uveitis in the left eye. Chest CT scan showed parenchymal abnormalities that could correspond to sarcoidosis. Skin biopsy revealed noncaseating granuloma. Oral and topical corticosteroids resulted in improvement of the condition. A 72-year-old female patient presented with cutaneous infiltration of the left upper eyelid for 1 month. Biopsy was consistent with sarcoidosis. Endobronchial biopsies showed interstitial fibrosis. Oral prednisone improved the condition. A 65-year-old female patient presented with edema of the right upper eyelid for 2 months. Full-thickness biopsy showed granuloma without necrosis. There was an improvement with oral steroid.Conclusion: Although eyelid involvement in sarcoidosis is uncommon, different forms of presentation, including destructive lesions, can be observed.
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Affiliation(s)
- Marina L Conti
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP, São Paulo, Brazil
| | - Midori H Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP, São Paulo, Brazil
| | - Ana Estela Sant'Anna
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP, São Paulo, Brazil
| | - Tammy H Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP, São Paulo, Brazil
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Samalia P, Hawley LJ, Niederer RL, Sims J. Review of de novo uveitis in older adults presenting to a large tertiary centre. Br J Ophthalmol 2021; 106:941-946. [PMID: 33597198 DOI: 10.1136/bjophthalmol-2020-318657] [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: 12/16/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The primary aim of this study was to describe the causes of de novo uveitis in individuals 60 years and older. Secondary objectives were to determine the incidence of intraocular lymphoma and the clinical predictors of lymphoma. METHODS Retrospective chart review of all subjects presenting to the uveitis service at Auckland District Health Board (Auckland, New Zealand) between January 2006 and October 2020 RESULTS: 686 subjects (900 eyes) were aged ≥60 years at first presentation with uveitis, representing 23.4% of all subjects with uveitis during the study period. Non-infectious aetiology occurred in 631 (70.1%) eyes and infectious etiologies occurred in 269 (29.9%) eyes. The most frequent causes were idiopathic (36.3%), herpes zoster (14.8%), HLAB27 (8.7%) and sarcoidosis (4.8%). Twenty (2.2%) eyes of 13 (1.9%) subjects had a diagnosis of lymphoma. Lymphoma represented 11.2% of all intermediate uveitis. Subjects diagnosed with lymphoma did not develop posterior synechiae, epiretinal membrane, cystoid macular oedema or ocular hypertension. CONCLUSIONS Intraocular lymphoma was uncommon in the overall cohort, but an important cause of intermediate uveitis. A diagnosis of lymphoma needs to be considered in any older subject with de novo intermediate uveitis. The lack of posterior synechiae, cystoid macular oedema, epiretinal membrane and ocular hypertension further increases the suspicion for lymphoma.
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Affiliation(s)
- Priya Samalia
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand .,Ophthalmology, The University of Auckland Department of Ophthalmology, Auckland, New Zealand
| | | | | | - Joanne Sims
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
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Sobolewska B, Baglivo E, Edwards AO, Kramer M, Miserocchi E, Palestine AG, Schwab IR, Zamir E, Doycheva D, Zierhut M. Drug-induced Sarcoid Uveitis with Biologics. Ocul Immunol Inflamm 2021; 30:907-914. [PMID: 33596386 DOI: 10.1080/09273948.2020.1850799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose/Objectives: to evaluate new onset uveitis or reactivated uveitis by biologic agents and characterize their features.Materials and Methods: This is a multicenter, retrospective case series. Patients under biologic therapy were included if they developed uveitis for the first time or experienced intraocular inflammation which was different in location or laterality to previous inflammation.Results: Sixteen patients were identified. The underlying disorders included ankylosing spondylitis, juvenile idiopathic arthritis, rheumatoid arthritis, and Behçet's Disease. The biologic agents associated with a first episode of uveitis (n = 11) or with a new recurrence of uveitis (n = 5) were etanercept, adalimumab, abatacept, infliximab, and golimumab. Sarcoidosis based on bihilar lymphadenopathy, other computer tomography-findings, or biopsy was diagnosed in five patients under therapy with etanercep, adalimumab, and abatacept. Additionally, seven patients developed clinical changes in their uveitis pattern, suggesting sarcoid uveitis.Conclusions: Biologic treatment-induced uveitis often presents as granulomatous disease.
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Affiliation(s)
- Bianka Sobolewska
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | | - Albert O Edwards
- Oregon Retina Division of Sterling Vision, Eugene, OR, and Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon, USA
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ivan R Schwab
- Department of Ophthalmology & Visual Science, University of California, Davis, Sacramento, California, USA
| | - Ehud Zamir
- Centre for Eye Research Australia, Melbourne, Australia
| | - Deshka Doycheva
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Manfred Zierhut
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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Iwata D, Namba K, Yamamoto T, Mizuuchi K, Saito W, Ohno S, Kitaichi N, Ishida S. Recent Clinical Features of Intraocular Inflammation in Hokkaido, Japan - Comparison with the Previous Decade. Ocul Immunol Inflamm 2021; 30:848-854. [PMID: 33571416 DOI: 10.1080/09273948.2020.1836565] [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] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to investigate the clinical features of intraocular inflammation (uveitis) in Hokkaido and to assess the etiology trends in comparison with those of our previous survey. METHODS We retrospectively reviewed the medical records of 1,616 new referral uveitis patients (1,020 females and 596 males) in Hokkaido University Hospital between 2004 and 2014. RESULTS Sarcoidosis was the most frequent etiology (17.4%), followed by Vogt-Koyanagi-Harada disease (8.1%), Behçet's disease (4.5%), and human leukocyte antigen B27 -associated uveitis (2.5%). The etiologies in 48.7% of the patients were unclassified. Compared to the previous survey between 1994 and 2003, the rate of Behçet's disease decreased and that of sarcoidosis increased. The rates of infectious uveitis and vitreoretinal lymphoma increased. CONCLUSION Although the order of the top four etiologies was the same in the two surveys, the rate of sarcoidosis increased and that of Behçet's disease decreased.
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Affiliation(s)
- Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taku Yamamoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- 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, Sapporo, Japan
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McKay KM, Lim LL, Van Gelder RN. Rational laboratory testing in uveitis: A Bayesian analysis. Surv Ophthalmol 2021; 66:802-825. [PMID: 33577878 DOI: 10.1016/j.survophthal.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/07/2023]
Abstract
Uveitis encompasses a heterogeneous group of clinical entities with the common feature of intraocular inflammation. In addition to patient history and examination, a focused set of laboratory investigations is frequently necessary to establish a specific diagnosis. There is limited consensus among uveitis specialists regarding appropriate laboratory evaluation for many distinct patient presentations. The appropriateness of a laboratory test for a given case of uveitis will depend on patient-specific as well as epidemiologic factors. Bayesian analysis is a widely used framework for the interpretation of laboratory testing, but is seldom adhered to in clinical practice. Bayes theorem states that the predictive value of a particular laboratory test depends on the sensitivity and specificity of that test, as well as the prevalence of disease in the population being tested. In this review we will summarize the performance of commonly-utilized laboratory tests for uveitis, as well as the prevalence of uveitic diagnoses in different geographic practice settings. We will propose a logical framework for effective laboratory testing in uveitic disease through rigorous application of Bayesian analysis. Finally, we will demonstrate that while many highly sensitive laboratory tests offer an effective means to rule out associated systemic disease, limited test specificity and low pretest probability often preclude the diagnosis of systemic disease association with any high degree of certainty, even in the face of positive testing.
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Affiliation(s)
- K Matthew McKay
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA; Department of Biological Structure, University of Washington, Seattle, Washington, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
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Hiyama T, Harada Y, Kiuchi Y. Efficacy and Safety of Adalimumab Therapy for the Treatment of Non-infectious Uveitis: Efficacy comparison among Uveitis Aetiologies. Ocul Immunol Inflamm 2021; 30:951-958. [PMID: 33560160 DOI: 10.1080/09273948.2020.1857791] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To assess the efficacy and safety of adalimumab treatment in patients with Non-infectious uveitis.Methods: This was a single-center retrospective chart review of patients with active Non-infectious uveitis who had received adalimumab in Japan. Outcome variables included change in systemic immunosuppressive treatment, intraocular inflammation, visual acuity, and relapse rate.Results: In total, 48 patients were included. After the initiation of adalimumab, more than 80% of the patients received systemic corticosteroid ≤5 mg from 3 months onwards. Intraocular inflammation, relapse rate, and visual acuity showed persistent improvement. Adalimumab and methotrexate combination therapy was required in 71.4% of the patients with Vogt-Koyanagi-Harada disease/sympathetic ophthalmia, whereas it was required in only 18.0% of the patients with Behçet's disease. There were no serious side effects that required discontinuation of adalimumab.Conclusion: Adalimumab is efficacious and safe for the treatment of patients with Non-infectious uveitis. Differences in the efficacy of adalimumab treatment may exist between patients with Vogt-Koyanagi-Harada disease/sympathetic ophthalmia and patients with Behçet's disease.
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Affiliation(s)
- Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Clinical features of uveitis in elderly patients in central Tokyo (2013-2018). Int Ophthalmol 2021; 41:1671-1679. [PMID: 33544350 DOI: 10.1007/s10792-021-01721-4] [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: 08/18/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To clarify the clinical features of uveitis in elderly patients in central Tokyo. METHODS We retrospectively identified 1424 patients with uveitis who visited the Uveitis Clinic of the University of Tokyo Hospital between January 2013 and December 2018. The patients were categorized into two groups based on their ages at the time of disease onset: patients aged 65 years or older were included in Group A, whereas those younger than 65 years were included in Group B. The etiological classification of uveitis and its causes were investigated for each group. RESULTS Group A presented significantly higher rates of infectious uveitis (35.5% vs. 17.8%, p < 0.0001) and masquerade syndromes (17.9% vs. 5.0%, p < 0.0001) than Group B. Furthermore, Group A had significantly higher rates of sarcoidosis (23.1% vs. 9.3%, p < 0.0001), intraocular lymphoma (16.6% vs. 4.6%, p < 0.0001), cytomegalovirus iritis (11.0% vs. 5.6%, p = 0.0043), and cytomegalovirus retinitis (5.2% vs. 1.5%, p = 0.0020) than Group B. CONCLUSION Our results demonstrate a clear difference in the causative diseases of uveitis between elderly and non-elderly patients. These findings may support ophthalmologists in their diagnostic process for elderly patients with uveitis.
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Hoegerl C, Amper A. A 46-Year-Old Presenting With Inferior Mononuclear Visual Field Defect as the Sole Manifestation of Neurosarcoidosis. Cureus 2021; 13:e13076. [PMID: 33728109 PMCID: PMC7948692 DOI: 10.7759/cureus.13076] [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] [Indexed: 11/05/2022] Open
Abstract
Neurosarcoidosis (NS) is a rare manifestation of sarcoidosis that lacks an organized body of knowledge regarding its diagnosis and management. There exists no clearly defined diagnostic criteria to make the diagnosis. To further complicate things, biopsy of the nervous system tissue remains complicated and not easily accomplished due to the sensitivity of the tissue and the subsequent deficits it could produce. In this case report, we present a patient who presented with acute inferior mononuclear quadrantanopsia with an insignificant past medical history and a lack of other signs and symptoms. Follow-up studies and magnetic resonance imaging of the orbits eventually led to the diagnosis of NS.
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Affiliation(s)
- Carl Hoegerl
- Internal Medicine and Neurology, Centra Health and Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Addie Amper
- Neurology, Liberty University College of Osteopathic Medicine, Lynchburg, USA
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El Jammal T, Loria O, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Sève P. Uveitis as an Open Window to Systemic Inflammatory Diseases. J Clin Med 2021; 10:E281. [PMID: 33466638 PMCID: PMC7828680 DOI: 10.3390/jcm10020281] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (Spa), Behçet's disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD's uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Olivier Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
- IMER Department, Hospices Civils de Lyon, 69424 Lyon, France
- Department of Formation and Research in Human Biology, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
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Smith JR, Matthews JM, Conrad D, Hall AJ, Niederer RL, Singh-Grewal D, Tay-Kearney ML, Wells JM, Zagora SL, McCluskey PJ. Recommendations for the management of childhood juvenile idiopathic arthritis-type chronic anterior uveitis. Clin Exp Ophthalmol 2021; 49:38-45. [PMID: 33426782 DOI: 10.1111/ceo.13856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Australian- and New Zealand-based, uveitis-specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)-type chronic anterior uveitis. BACKGROUND Historically, the visual prognosis of JIA-type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. DESIGN This work involved a consensus survey and a panel meeting. PARTICIPANTS The Australian and New Zealand JIA-Uveitis Working Group (29 ophthalmologists) participated in the work. METHODS The Delphi technique was used to achieve consensus. MAIN OUTCOME MEASURES This work yielded consensus statements. RESULTS The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non-corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA-type uveitis. CONCLUSIONS AND RELEVANCE Recommendations of the Australian and New Zealand JIA-Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.
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Affiliation(s)
- Justine R Smith
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Janet M Matthews
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Diana Conrad
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael L Niederer
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Davinder Singh-Grewal
- Department of Rheumatology, The Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of NSW School of Women and Children's Health, Sydney, New South Wales, Australia.,University of Sydney Discipline of Child & Adolescent Health, Sydney, New South Wales, Australia
| | - Mei-Ling Tay-Kearney
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jane M Wells
- Ophthalmology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Sophia L Zagora
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Peter J McCluskey
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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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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135
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Nishisho R, Kusuhara S, Sotani N, Kim KW, Katsuyama-Yoshikawa A, Matsumiya W, Akashi K, Morinobu A, Nakamura M. Changes in choroidal imaging parameters following adalimumab therapy for refractory noninfectious uveitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1273-1280. [PMID: 33415356 DOI: 10.1007/s00417-020-05032-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the short-term change in choroidal structure following adalimumab (ADA) treatment in refractory noninfectious uveitis. METHODS This was a retrospective study of 33 eyes from 18 patients with refractory noninfectious uveitis. Subfoveal choroidal thickness (SFCT), the choroidal stromal index (CSI) defined as the proportion of stromal area to the total choroidal area were used as choroidal imaging parameters and were evaluated by enhanced depth imaging optical coherence tomography (EDI-OCT). The change in these parameters in the 2 months following initiation of ADA was analysed. A linear mixed-effect model was used to assess the effect of ADA treatment. RESULTS The causes of uveitis were Vogt-Koyanagi-Harada disease (VKHD) (42.4%), presumed autoimmune retinopathy (15.2%), others (12.1%) and unclassified (30.3%). In the analysis of all eyes, the SFCT was 309.7 ± 113.1 μm at baseline, 295.7 ± 114.5 μm at 1 month and 275.2 ± 98.8 μm at 2 months after ADA initiation (P < 0.001). The CSI was 0.275 ± 0.050 at baseline, 0.273 ± 0.068 at 1 month and 0.273 ± 0.046 at 2 months (P = 0.785). In the subgroup analysis, the SFCT decreased significantly from baseline to 2 months in VKHD eyes (P = 0.007) and unclassified eyes (P = 0.034). There was no significant change in CSI in either subgroup. CONCLUSIONS In the assessment of short-term response to ADA treatment in uveitic eyes, using EDI-OCT, the SFCT appears to be more effective as a choroidal imaging biomarker than the CSI, especially in VKHD eyes.
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Affiliation(s)
- Ryuto Nishisho
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Noriyuki Sotani
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kyong Woo Kim
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Atsuko Katsuyama-Yoshikawa
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kengo Akashi
- Section of Rheumatology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akio Morinobu
- Section of Rheumatology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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136
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Shimizu H, Usui Y, Asakage M, Nezu N, Wakita R, Tsubota K, Sugimoto M, Goto H. Serum Metabolomic Profiling of Patients with Non-Infectious Uveitis. J Clin Med 2020; 9:jcm9123955. [PMID: 33291298 PMCID: PMC7762156 DOI: 10.3390/jcm9123955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
The activities of various metabolic pathways can influence the pathogeneses of autoimmune diseases, and intrinsic metabolites can potentially be used to diagnose diseases. However, the metabolomic analysis of patients with uveitis has not yet been conducted. Here, we profiled the serum metabolomes of patients with three major forms of uveitis (Behҫet's disease (BD), sarcoidosis, and Vogt-Koyanagi-Harada disease (VKH)) to identify potential biomarkers. This study included 19 BD, 20 sarcoidosis, and 15 VKH patients alongside 16 healthy control subjects. The metabolite concentrations in their sera were quantified using liquid chromatography with time-of-flight mass spectrometry. The discriminative abilities of quantified metabolites were evaluated by four comparisons: control vs. three diseases, and each disease vs. the other two diseases (such as sarcoidosis vs. BD + VKH). Among 78 quantified metabolites, 24 kinds of metabolites showed significant differences in these comparisons. Four multiple logistic regression models were developed and validated. The area under the receiver operating characteristic (ROC) curve (AUC) in the model to discriminate disease groups from control was 0.72. The AUC of the other models to discriminate sarcoidosis, BD, and VKH from the other two diseases were 0.84, 0.83, and 0.73, respectively. This study provides potential diagnostic abilities of sarcoidosis, BD, and VKH using routinely available serum samples that can be collected with minimal invasiveness.
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Affiliation(s)
- Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Ryo Wakita
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Masahiro Sugimoto
- Health Promotion and Preemptive Medicine, Research and Development Center for Minimally Invasive Therapies, Institute of Medical Sciences, Tokyo Medical University, Tokyo 160-8402, Japan;
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
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137
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Jacobs T, Thal DR, Weynand B, Van Calster J, Van Ginderdeuren R. Analysis of Vitreous Samples by the Cellient ® Automated Cell Block System: A Six-year Review of Specimens in a Uveitis Population. Ocul Immunol Inflamm 2020; 30:781-788. [PMID: 33269981 DOI: 10.1080/09273948.2020.1830123] [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: 10/22/2022]
Abstract
Purpose: To further evaluate the value of a standardized method to analyze vitreous samples using the Cellient® automated cell block system in the diagnosis of unsolved uveitis.Methods: Six hundred sixty-four pure vitreous samples obtained from patients with unsolved uveitis between March 2012 and May 2018 at University Hospitals Leuven, fixed in PreservCyt® and processed by the Cellient tissue processor, were included in the study.Results: In 86.3% of the cases, sufficient material was found for diagnosis. A diagnosis of acute inflammation was made in 20.2% of the cases. In 34.0% of the cases, the diagnosis was chronic active inflammation; in 26.5%, low-grade inflammation; and in 5.6%, a malignant process.Conclusion: Our standardized protocol can be used to diagnose endophthalmitis, lymphoma, granulomatous disease, inactive and storage disease, and metastatic infiltration. Cellient analysis of vitreous specimens had a diagnostic yield of 86.3% in unsolved uveitis cases.
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Affiliation(s)
- Tine Jacobs
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Rita Van Ginderdeuren
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
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138
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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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139
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Teo HMT, Elner SG, Sassalos TMP, Elner VM, Demirci H. Ciliary Body Mass as a Feature of Ocular Sarcoidosis. JAMA Ophthalmol 2020; 138:300-304. [PMID: 32027347 DOI: 10.1001/jamaophthalmol.2019.5704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Ocular sarcoidosis may be the primary and only clinical manifestation of sarcoidosis, and irreversible loss of visual acuity may occur from delayed treatment. Thus, early diagnosis is imperative to preserve visual acuity. Establishing the diagnosis of sarcoidosis in cases manifesting only in the eye may require a diagnostic biopsy, which may prove challenging in the absence of available ocular surface, lacrimal gland, and systemic tissue for biopsy. Objective To describe diffuse or segmental ciliary body mass as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis. Design, Setting, and Participants This case series captures 3 cases from a university-based ocular oncology and uveitis practice. All 3 patients presented with uveitis and a diffuse or segmental ciliary body mass, which was identified via ultrasonographic biomicroscopy. Main Outcomes and Measures Clinical, ancillary, and histopathological ocular findings in the 3 patients. Results The patients were a 52-year-old white woman, a 42-year-old African American man, and an 81-year-old white man. Two individuals had unilateral involvement, and 1 had bilateral involvement. All 3 individuals presented with uveitis. Diffuse, circumferential ciliary body masses were observed in 2 patients. A localized, nodular ciliary body mass on the temporal quadrant with superior and inferior extensions was observed in 1 patient. Moderate to high internal reflectivity was observed on ultrasonographic biomicroscopy in all 3 individuals. Biopsies of the ciliary body masses were diagnosed as sarcoidosis in all 3 patients. Conclusions and Relevance These findings support that diffuse or segmental ciliary body mass may serve as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis, although the frequency of this cannot be determined from 3 cases. To our knowledge, such cases all demonstrate a uveitic component; whether a ciliary body mass caused by sarcoidosis can occur in the absence of uveitis remains unknown.
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Affiliation(s)
- Honeylen Maryl Tiu Teo
- Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Susan G Elner
- Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
| | | | - Victor Maurice Elner
- Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Hakan Demirci
- Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
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140
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Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
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Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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141
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Abstract
PURPOSE OF REVIEW Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease. RECENT FINDINGS The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation. SUMMARY Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.
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Affiliation(s)
- De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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142
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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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143
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Takase H, Acharya NR, Babu K, Bodaghi B, Khairallah M, McCluskey PJ, Tesavibul N, Thorne JE, Tugal-Tutkun I, Yamamoto JH, Rao NA, Smith JR, Mochizuki M. Recommendations for the management of ocular sarcoidosis from the International Workshop on Ocular Sarcoidosis. Br J Ophthalmol 2020; 105:1515-1519. [PMID: 32933934 DOI: 10.1136/bjophthalmol-2020-317354] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 08/15/2020] [Accepted: 08/22/2020] [Indexed: 12/29/2022]
Abstract
AIMS To establish expert recommendations for the management of ocular sarcoidosis (OS). METHODS A question-based survey on the management of OS was circulated to international uveitis experts (members of the International Uveitis Study Group and the International Ocular Inflammation Society) electronically. Subsequently, a consensus workshop was conducted at the 7th International Workshop on Ocular Sarcoidosis (IWOS) in June 2019 in Sapporo, Japan as part of the Global Ocular Inflammation Workshops. Statements on the management of OS that were supported by a two-thirds majority of 10 international panel members of the workshop, after discussion and voting, were taken as consensus agreement. RESULTS A total of 98 participants from 29 countries responded to the questionnaire survey. The subsequent consensus workshop established recommendations for the management of OS in five sections. The first section concerned evaluation and monitoring of inflammation. The second, third and fourth sections described ocular manifestations that were indications for treatment, and the management of anterior uveitis, intermediate uveitis and posterior uveitis. In the fifth section, the use of systemic corticosteroids and systemic immunosuppressive drugs were detailed. CONCLUSIONS Recommendations for management of OS were formulated through an IWOS consensus workshop.
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Affiliation(s)
- Hiroshi Takase
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nisha R Acharya
- Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Kalpana Babu
- Prabha Eye Clinic and Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Peter J McCluskey
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jennifer E Thorne
- Division of Ocular Immunology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, BaltimoreMD, USA
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Joyce H Yamamoto
- Department of Ophthalmology, Faculdade de Medicina LIM-33 FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
| | - Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan .,Miyata Eye Hospital, Miyakonojo, Japan
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144
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Cotte P, Pradat P, Kodjikian L, Jamilloux Y, Seve P. Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis. Br J Ophthalmol 2020; 105:1399-1404. [PMID: 32917626 PMCID: PMC8479750 DOI: 10.1136/bjophthalmol-2020-316563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Aim To evaluate the diagnostic worth of elevated serum ACE (sACE) and lymphopaenia, singly or combined, in diagnosing sarcoid uveitis. Methods Monocentric retrospective study, on a cohort of 996 adult patients referred to our department between March 2001 and December 2018 for a diagnostic work-up of uveitis. The sensitivity (SE), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the two biomarkers were calculated in different contexts. Results Eight hundred and sixty-eight patient cases were reviewed. The mean age at uveitis onset was 49.4 (±18.6) years. Of them, 144 patients had a diagnosis of sarcoid uveitis. An elevated sACE had SE of 45.8%, Sp of 88.8%, PPV of 44.9% and NPV of 89.2% in diagnosing sarcoid uveitis. For lymphopaenia, SE was 15.3%, Sp was 96.7%, PPV was 47.8% and NPV was 85.2%. For the combination of elevated sACE and lymphopaenia, SE was 18.9%, Sp was 99.0%, PPV was 73.9% and NPV was 89.5%. The value of this combination varied according to patient age at diagnosis plus anatomoclinical entities: for patients aged ≤50 years, SE was 31.3%, Sp was 99.7%, PPV was 90.9% and NPV was 94.3%. For granulomatous uveitis, SE was 26.2%, Sp was 97.3%, PPV was 73.3% and NPV was 82.5%. Conclusion A combination of elevated serum ACE and lymphopaenia more convincingly suggests sarcoid uveitis than these investigational tests used alone, especially in patients with granulomatous uveitis, while a lack of these markers corresponds to a high NPV. Trial registration number NCT03863782.
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Affiliation(s)
| | - Pierre Pradat
- Centre for Clinical Research, Hôpital De La Croix-Rousse, Lyon, France
| | | | - Yvan Jamilloux
- Internal Medicine, Hôpital de la Croix-Rousse, Lyon, France
| | - Pascal Seve
- Internal Medicine, Hôpital de la Croix-Rousse, Lyon, France .,Hospices Civils de Lyon, Lyon, France
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145
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Chest X-ray and Uveitis Evaluation in a Population with Low Incidence of Sarcoidosis. Ophthalmol Ther 2020; 9:577-584. [PMID: 32613593 PMCID: PMC7406623 DOI: 10.1007/s40123-020-00274-6] [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: 05/18/2020] [Indexed: 11/01/2022] Open
Abstract
Introduction Methods Results Conclusions
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146
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Kunimi K, Usui Y, Asakage M, Maehara C, Tsubota K, Mitsuhashi R, Umazume A, Kezuka T, Sakai JI, Goto H. Anti-TNF-α Therapy for Refractory Uveitis Associated with Behçet's Syndrome and Sarcoidosis: A Single Center Study of 131 Patients. Ocul Immunol Inflamm 2020; 30:223-230. [PMID: 32815752 DOI: 10.1080/09273948.2020.1791346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The efficacy of infliximab (IFX) and adalimumab (ADA) for treating Behçet's syndrome (BS) and sarcoidosis has not been compared adequately. METHODS We reviewed the medical records of patients with uveitis diagnosed at Tokyo Medical University Hospital and compared the efficacy of IFX and ADA for BS and the efficacy of ADA for sarcoidosis and BS. RESULTS 68 patients in IFX group and 63 patients in ADA group were analyzed. In BS patients, IFX and ADA were both effective in improving uveitic macular edema (UME). ADA improved UME in BS but not in sarcoidosis patients. The efficacy of ADA in reducing doses of corticosteroids and glaucoma medications was better in sarcoidosis than in the BS group. CONCLUSION Both IFX and ADA are efficacious in improving UME in BS patients. The reason that ADA improves UME better in BS than in sarcoidosis may be due to the difference in pathogenesis between these diseases.
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Affiliation(s)
- Keiko Kunimi
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Masakai Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Chihiro Maehara
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | | | - Akihiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Kezuka
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Jun-Ichi Sakai
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
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147
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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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148
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Dammacco R, Biswas J, Kivelä TT, Zito FA, Leone P, Mavilio A, Sisto D, Alessio G, Dammacco F. Ocular sarcoidosis: clinical experience and recent pathogenetic and therapeutic advancements. Int Ophthalmol 2020; 40:3453-3467. [PMID: 32740881 PMCID: PMC7669777 DOI: 10.1007/s10792-020-01531-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
Purpose To describe the ocular manifestations in a cohort of patients with systemic sarcoidosis (SS). Recent advances in the pathophysiology, diagnosis, and therapy of SS are also discussed. Methods Data from 115 Italian patients diagnosed between 2005 and 2016 were retrospectively reviewed. All but the first 17 patients underwent a comprehensive ophthalmologic examination. The diagnosis was based on clinical features, the demonstration of non-caseating granulomas in biopsies from involved organs, and multiple imaging techniques. Data on broncho-alveolar lavage fluid analysis, calcemia, calciuria, serum angiotensin-converting enzyme levels and soluble interleukin-2 receptor levels were retrieved when available. Results Ocular involvement, detected in 33 patients (28.7%), was bilateral in 29 (87.9%) and the presenting feature in 13 (39.4%). Anterior uveitis was diagnosed in 12 patients (36.4%), Löfgren syndrome and uveoparotid fever in one patient each (3%), intermediate uveitis in 3 patients (9.1%), posterior uveitis in 7 (21.2%), and panuveitis in 9 (27.3%). First-line therapy consisted of corticosteroids, administered as eyedrops (10 patients), sub-Tenon’s injections (1 patient), intravitreal implants (9 patients), or systemically (23 patients). Second-line therapy consisted of steroid-sparing immunosuppressants, including methotrexate (10 patients) and azathioprine (10 patients). Based on pathogenetic indications that tumor necrosis factor (TNF)-α is a central mediator of granuloma formation, adalimumab, targeting TNF-α, was employed in 6 patients as a third-line agent for severe/refractory chronic sarcoidosis. Conclusion Uveitis of protean type, onset, duration, and course remains the most frequent ocular manifestation of SS. Diagnostic and therapeutic advancements have remarkably improved the overall visual prognosis. An ophthalmologist should be a constant component in the multidisciplinary approach to the treatment of this often challenging but intriguing disease.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland
| | | | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Alberto Mavilio
- Social Health District, Glaucoma Center, Azienda Sanitaria Locale, Brindisi, Italy
| | - Dario Sisto
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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149
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 455] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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150
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Handa-Miyauchi M, Takase H, Tanaka M, Akiyama M, Ohno-Matsui K, Mochizuki M. A Validation Study of the Revised Diagnostic Criteria from the International Workshop on Ocular Sarcoidosis at a Single Institute in Japan. Ocul Immunol Inflamm 2020; 29:1501-1506. [DOI: 10.1080/09273948.2020.1758159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Mari Handa-Miyauchi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology, Tokyo Metropolitan Health and Medical Treatment Corporation, Tama-Hokubu Medical Center, Tokyo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miyuki Tanaka
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masako Akiyama
- Research Administration Divisions, Research University Promotion Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manabu Mochizuki
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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