Retinal Sarcoidosis: A Case Series with New Insights from Multi-Modal Imaging of 23 Lesions

To describe multi-modal imaging of intra-retinal sarcoidosis.

Case series and literature review. Patients were included if they had presumed or definite ocular sarcoidosis and optical coherence tomography (OCT) evidence of intra-retinal lesions.

In total, 23 retinal lesions from six patients with were included. All patients were female and Caucasian, with a mean age of 81 years (range 73-88 years). The lesions were ovoid 20/23 (87%) and hyper-reflective 23/23 (100%) on OCT. Retinal pigment epithelial (RPE) atrophy was identified in 12/23 (52%) and RPE elevation in 8/23 (35%). Out of 13 retinal lesions that had a follow up OCT post-corticosteroid treatment, 7 (54%) completely resolved and 6 (46%) were smaller. The lesions were hyporeflective on near infrared imaging (12/17, 71%), hypo-autofluorescent (12/15, 80%), hyperfluorescent on fluorescein angiography (15/17, 88%) and hypofluorescent (12/17, 71%) on indocyanine green angiography. Literature review identified only five other studies describing 9 lesions of intra-retinal sarcoidosis confirmed on OCT.

Ocular sarcoidosis can present with intra-retinal lesions that are ovoid and hyper-reflective on OCT, hyporeflective on near infrared, hypoautofluorescent, hyperfluorescent on FFA and hypo- or isofluorescent on ICGA. New findings of retinal sarcoidosis include multi-modal imaging characteristics, foveal involvement, associated photoreceptor or RPE atrophy and spontaneous resolution and recurrence. Identification of intra-retinal sarcoid lesions can assist in diagnosis and should be considered for inclusion in future diagnostic criteria. Prompt treatment of macular lesions with corticosteroids is recommended to avoid photoreceptor or RPE atrophy with permanent visual loss.