Use of wide‐field fluorescein angiography in the diagnosis and management of sarcoidosis uveitis

Abstract

PurposeTo assess the utility of wide field (WF) fluorescein angiography versus conventional angiography in the diagnosis and management of Sarcoidosis posterior uveitis.MethodsTwenty‐three eyes of 12 patients diagnosed with Sarcoidosis disease who underwent WF fluorescein angiography imaging with the Heidelberg scanning laser ophthalmoscope HRA2 using the Staurenghi SLO contact lens between January 2016 and March 2017 were included in our study. Complete clinical and imaging records (WF fluorescein angiography and SD‐OCT) of the patients were retrospectively reviewed. A circle simulating the central 75‐degree field was drawn on WF fluorescein angiography images. We compared the WF fluorescein angiography findings within the circle and the complete image and assessed its impact on patient management.ResultsFourteen eyes of 23 (60.9%) were diagnosed with Sarcoidosis retinal vasculitis. WF fluorescein angiography revealed vasculitis not clinically evident in 9 of 14 eyes (64.3%). Predominant angiographic findings were diffuse vascular leakage in 6 eyes (26.1%), peripheral ischemia in 5 eyes (21.7%), vein sheathing in 12 eyes (52.2%) and multifocal hyperfluorescent spots in 8 eyes (34.8%). Ten eyes (43.5%) had no apparent retinal vasculitis but WF images have shown peripheral changes outside the circle. In four eyes (13%), WF fluorescein angiography showed the vasculitis to be much more extensive than usually seen by simulated conventional FA. WF fluorescein angiography influenced treatment decision in 9 eyes (39.1%).ConclusionsRetinal vasculitis (RV) may be difficult to detect either clinically or with conventional retinal imaging in Sarcoidosis disease. Wide‐field imaging is a useful tool in the diagnosis of RV associated to Sarcoidosis disease even in the absence of clinical retinal vasculitis and may influence management decisions.