[Diagnostic evaluation of sarcoid choroidal granuloma using high-penetration optical coherence tomography]

We report a case of sarcoidosis that manifested as choroidal granuloma. We followed the treatment-associated changes in the granulomatous lesion by serial examinations using high-penetration optical coherence tomography (HP-OCT).

A 77-year-old woman, who was referred to our clinic with granulomatous uveitis, presented initially with a yellowish-white subretinal granuloma formation surrounding the left optic disk. On presentation, diffuse keratic precipitates, anterior chamber inflammation and snowball-like vitreous opacity were observed. The HP-OCT image of subretinal lesion showed a low density choroidal space-occupying lesion. Due to the presence of bilateral hilar lymphadenopathy based on a close inspection of the entire body and abnormal cardiac/mediastinal uptake with positron emission tomography in combination with computed tomography (PET-CT), the definite clinical diagnosis group of sarcoidosis was made. Sub-Tenon injection of triamcinolone acetonide (STTA) was administered. In response to the treatment, HP-OCT showed that the choroidal granuloma had disappeared. Six months after treatment, the lesion recurred, however, this choroidal lesion resolved on OCT within the following 6 months in response to an STTA injection. As a complete atrioventricular block was observed during the follow-up, a pacemaker was implanted.

The findings and clinical course strongly suggested choroidal granuloma of ocular sarcoidosis. HP-OCT allowed a detailed observation of the space-occupying lesion and helped make a diagnosis and observe the course of treatment.