Bilateral Vitreous Hemorrhage: An Unusual Presentation of Presumed Ocular Sarcoidosis-Case Report

Abstract

Purpose: TO report a rare case of presumed sarcoidosis presented as bilateral recurrent vitreous hemorrhage Method: a case report Results: a 35-year-old woman was referred to our department by a local medical doctor due to severe visual impairment for months. She was quite healthy prior to a recurrent episode of uveitis with mutton fat keratic precipitates (Kps) in both eyes since 2002. The initial visual acuity was counting finger in right eye and hand motion in left eye. The slit-lamp microscope showed mild anterior chamber reaction in both eyes. Ophthalmoscopy and B-scan revealed dense vitreous hemorrhage without retinal detachment in both eyes. The results of systemic workup including general physical examination, blood routine, Rheumatic factor (RF), nuclear antibody (ANA), human immunodeficiency virus (HIV), venereal disease research laboratory test (VDRL), anti-cardiolipin antibody, and chest radiography, were within normal ranges. As a result of the persistent vitreous hemorrhage and disabled vision, pars plana vitrectomy was performed in the left eye on May 7(superscript th), 2003 and then the right eye on Jun 25(superscript th), 2003. Sign of peripheral vasculitis with nodular choroid infiltration were noted during the operation in both eyes and aqueous for TB culture and PCR was negative. Gallium-67 scans showed a panda sign of increased uptake in lacrimal 9 lands and lambda sign of lymphnodes in the mediastinum. According to the ophthalmologic and image findings, the case 15 verified to be presumed ocular sarcoidosis. Conclusion: ocular sacoidosis may be present in various forms of ocular diseases. Hence, in a case of unknown vitreous hemorrhage and uveitis, presumed sarcoidosis should be on the list of differential diagnosis.