Abstract

The distribution of age at diagnosis in ocular sarcoidosis has shifted towards the older age groups in developed countries. In systemic sarcoidosis, age-related differences in the clinical presentation, which reflect the therapeutic strategies, was reported. We retrospectively compared 100 consecutive patients from April 2010 to March 2016 who were initially diagnosed with ocular sarcoidosis by International Workshop on Ocular Sarcoidosis criteria. They were classified into elder (>65 years: 50 patients) and younger (≤65 years: 50 patients) groups by the age at diagnosis of uveitis associated with sarcoidosis. All patients received ophthalmic examination to assess the presence of seven intraocular signs and 4 laboratory parameters. Significantly fewer ocular signs (2.8 ± 1.5 and 3.6 ± 1.5; P = 0.0034) and abnormal laboratory results (1.5 ± 1.2 and 2.0 ± 1.2; P = 0.023) were detected in the elder group than in the younger group; statistical differences were found between the groups regarding the frequencies of mutton-fat keratic precipitates (40% and 64%; P = 0.012), vitreous opacities (60% and 78%; P = 0.0059), bilateral inflammation (64% and 80%; P = 0.012), and bilateral hilar lymphadenopathy between the groups (52% and 78%; P < 0.001). Multiple linear regression analysis showed negative correlations between age and number of detected ocular signs (r = −0.36, P < 0.001) and laboratory results (r = −0.20, P = 0.023). The characteristic ocular signs and abnormal laboratory results had a lower frequency in the elder patients compared with the younger patients. Probable or possible ocular sarcoidosis by the international criteria should increase with increased life expectancy in developed countries.

Highlights

  • Sarcoidosis is a chronic inflammatory disease characterised by the formation of non-caseating granulomas in multiple tissues and organs, including the eye [1, 2]

  • For the defined ocular signs, the frequencies of keratic precipitates (KP), vitreous opacities (VO) and bilateral inflammation were significantly higher in the younger group (64%, 78% and 80%, respectively) than in the elder group (40%, 60% and 64%, respectively)

  • We compared the presence of the characteristic ocular signs and laboratory investigations for ocular sarcoidosis between elder and younger patients, and our results indicated that the frequencies of KP, VO and bilateral hilar lymphadenopathy (BHL) are lower in elderly patients than in younger patients, and that the frequencies decrease on an age-dependent basis

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Summary

Introduction

Sarcoidosis is a chronic inflammatory disease characterised by the formation of non-caseating granulomas in multiple tissues and organs, including the eye [1, 2]. Usefulness of conjunctival and lacrimal gland biopsies for diagnosing ocular sarcoidosis have been reported [10, 11], these are not sensitive for sarcoidosis patients with uveitis. In 2009, the International Workshop on Ocular Sarcoidosis (IWOS) drafted a set of guidelines for characterising uveitis patients suspected of having sarcoidosis. These guidelines designate four diagnostic categories: definite, presumed, probable or possible ocular sarcoidosis [12]. Diagnosis of definite ocular sarcoidosis requires biopsy [13, 14], effort has been made to determine which clinical signs and laboratory results are useful for correctly diagnosing sarcoidosis in patients with uveitis

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