Abstract
BackgroundSarcoidosis is an idiopathic, multi-system, granulomatous disease with well-described ocular manifestations. However, other uveitic etiologies can manifest in a similar fashion, and ocular disease may precede systemic manifestations. Definitive diagnosis requires histologic confirmation of non-caseating granulomatous inflammation. This study reports the diagnostic yield of directed biopsy of conjunctival follicles in patients with uveitis suspected to be secondary to sarcoidosis, and compares an institutional standard tissue sectioning method to a multi-plane technique.ResultsA retrospective analysis was performed of all patients who underwent directed conjunctival biopsy for suspected ocular sarcoidosis. A total of eight patients were identified; all were females. Directed conjunctival biopsy was positive in three of seven patients using standard histologic processing method, a yield of 43%. Using the multi-plane technique increased the cumulative yield to 63%.ConclusionsDirected conjunctival biopsy is a minimally invasive, cost-effective, and moderately high yield method of diagnosing ocular sarcoidosis. Using a multi-plane sectioning method may increase biopsy yield when standard sectioning techniques are negative.
Highlights
Sarcoidosis is an idiopathic, multi-system, granulomatous disease with well-described ocular manifestations
This study highlights the diagnostic utility of directed conjunctival biopsy and compares an institutional standard tissue sectioning method to a multi-plane sectioning technique
Conjunctival follicles have been reported in 7% to 17% of patients with ocular sarcoidosis [13,14]
Summary
Sarcoidosis is an idiopathic, multi-system, granulomatous disease with well-described ocular manifestations. This study reports the diagnostic yield of directed biopsy of conjunctival follicles in patients with uveitis suspected to be secondary to sarcoidosis, and compares an institutional standard tissue sectioning method to a multi-plane technique. Definitive diagnosis requires histologic evidence of non-caseating, granulomatous inflammation, commonly from biopsy of mediastinal lymph nodes. Another potential biopsy site is the conjunctiva, with a reported diagnostic yield ranging from 20% to 70% with blind biopsies [1-4] and 36% to 75% with directed biopsies [5-8]. This study highlights the diagnostic utility of directed conjunctival biopsy and compares an institutional standard tissue sectioning method to a multi-plane sectioning technique
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