Visual loss in sarcoid-related uveitis

To assess the visual acuity outcome after treatment, in patients with differing types of uveitis associated with sarcoidosis, and to determine the types of sight-threatening complications.

This was an retrospective, non-comparative, interventional study of patients who had uveitis with a confirmed diagnosis of sarcoidosis and a minimum follow-up duration of 6 months from presentation. The worst affected eye at presentation was selected for the study. Complications causing impaired vision were documented, changes in visual acuity after completion of treatment were measured, and the risk of 'poor outcome' (visual acuity 6/12 and less) was compared in the various types of uveitis, using 'exact' multiple logistic regression to control confounding by other prognostic factors.

Seventy-five patients were studied. The spectrum of ocular inflammation in sarcoidosis is wide. Presentation may be acute and non-granulomatous or chronic and granulomatous with posterior segment involvement being varied. Poor visual outcome was significantly more frequent in multifocal choroiditis (5/7, 71.4%), and in panuveitis without multifocal choroiditis (13/28, 46.4%), compared to only 3/24 (12.5%) patients with anterior uveitis. The excess risks remained significant after adjustment for confounding effects of other prognostic factors including age, sex and manifest systemic sarcoidosis. Causes of visual loss were cataract, glaucoma, macular oedema, vitreous haemorrhage and retinal detachment.

Multifocal choroiditis is a less common manifestation of uveitis associated with sarcoidosis but appears to be associated with a worse visual prognosis despite immunosuppressive therapy.