INTRODUCTION:
Sarcoidosis is a chronic multisystemic granulomatous disorder with protean ocular and systemic manifestations due to exaggerated immune response to variety of self and non self-antigens. Manifestations of sarcoidosis are predomintantly intra thorasic with pulmonary infiltration and hilar lymphadenopathy, but other sites such as eyes, skin, bones & joints are also affected6. The clinical course of sarcoidosis varies from acute, self-limited process to a chronic progressive one, leading to severe functional impairment.
Ocular sarcoidosis can be considered as an example of chronic granulomatous non infectious pan uveitis.
AIM OF THE STUDY:
To study the clinical manifestations, diagnostic indicators and prognostic indicators of ocular sarcoidosis.
OBJECTIVES:
1. To study the clinical pattern of ocular sarcoidosis.
2. To study the various parameters that are used for the diagnosis of ocular sarcoidosis.
3. To study the prognosticators of ocular sarcoidosis.
MATERIALS AND METHODS:
Setting: University affiliated teaching centre attatched to a community based eye hospital offering primary to tertiary care Centre: Aravind Eye Hospitals, Madurai.
Department: Uvea clinic and Uveitis services, Aravind Eye Hospitals, Madurai.
Period of study: May 2009 to December 2010.
Sample size: 50 patients, 73 eyes.
Procedure for data collection: case selection, clinical examination and filling up of proforma. Data was entered into microsoft excel spreadsheets and analysed using STATA software.
Patients and uveitis workup:
Inclusion criteria:
All patients who presented to uvea clinic of Aravind Eye Hospital between April 2009 to December 2010 with definitive signs of intraocular inflammation compatible with a diagnosis of ocular sarcoidosis 42 were included in the study.
Exclusion criteria:
Patients with classical systemic features pointing to other differentials, those with established histological or serological evidence of other entities, patients with no follow up, patients with other co existing, comorbid conditions.
RESULTS:
73 eyes of 50 patients with a probable diagnosis of ocular sarcoidosis, who fitted into our inclusion criteria were studied. The mean duration of follow up for these patients was 6 months. Demographic charecteristics studied have been summarised in tables 1. The mean age of presentation was 38 years ranging from 12 to 67 years. The mean age of presentation among males was 32 years and among females was 46 years. There was a predilection for female gender with 62% and males attributing to 38%. These values have also been represented in terms of pie chart (fig 5). On evaluating the systemic features associated, no exact symptomatic presentation was noted. Findings of bilateral hilar lymphadenopathy and elevated liver enzymes were noticed in 18 (out of 50) and 1 (out of 7) of patients respectively.
CONCLUSION:
Sarcoidosis is a chronic granulomatous inflammation having various systemic and ocular manifestations. In our study we have analsed the different clinical manifestations, diagnostic parameters and prognosticators relating to ocular sarcoidosis in our population. From our results we find that the commonest clinical presentation of ocular sarcoidosis was of chronic anterior uveitis with intermediate uveitis.
Significant diagnostic indicators were cutaneous anergy to tuberculoprotein, radiological evidence of hilar lymphadenopathy and elevated serum ACE levels. Favourable prognosticators were location of the uveitis as anterior and intermediate uveitis, absence of sight threatening complications in the initial visit, absence of multiple recurrences over the course of disease.
Treatable complications like complicated cataract and glaucoma also had a favourable outcome. But no statistically significant correlation could be drawn between these parameters as the initial presenting visual acuity was good in majority of the cases. These results seem to correlate well with the results drawn from Japanese and European population studies that were conducted
