Clinical Features and Treatments of Severe Ocular Sarcoidosis

Kenichi NambaJapan Speaker Clinical feature and treatments of severe ocular sarcoidosisThe most common cause of uveitis in Japan is ocular sarcoidosis. Only cases meeting the diagnostic criteria qualify as ocular sarcoidosis, but the total number of suspected cases that do not meet the criteria is also significant. Ocular sarcoidosis presents with a wide range of ocular findings, affecting areas from the anterior to the posterior segment, and shows considerable individual variation. It often presents with little anterior chamber inflammation or vitreous opacity, frequently arising from elevated intraocular pressure due to gonio nodules, sometimes leading to misdiagnosis as primary open-angle glaucoma. Conversely, it can also present with severe findings, including marked vitreous haze, retinal vascular sheathing, retinal exudates, and cystoid macular edema, potentially leading to permanent visual impairment. The clinical course also varies significantly between individuals. Some cases resolve with a single treatment, remain stable without recurrence, and have a favorable visual prognosis. However, other cases involve prolonged inflammation necessitating long-term treatment. In such protracted cases, complications such as concomitant cataracts, secondary glaucoma, and macular degeneration frequently lead to visual impairment. Sarcoidosis is a disease relatively responsive to steroid therapy. Treatment primarily involves steroid eye drops along with mydriatic eye drops. If eye drops do not respond, oral steroids or periocular steroid injections are used. Oral methotrexate or oral adalimumab may sometimes be necessary. However, ocular sarcoidosis is a disease manifesting in waves of symptoms, and often resolves spontaneously. I will present actual cases and discuss the above points accordingly.