Clinical and Experimental Ophthalmology 2003; 31: 310–316 Original Article _____________________________________ Original Article Visual loss in sarcoid-related uveitis Aires Lobo MRCOphth, 1 Keith Barton FRCOphth, 2 Darwin Minassian FRCOphth, 3 Roland M du Bois FRCP 4 and Susan Lightman FRCOphth 2,5 1 Department of Ophthalmology, Kings College Hospital, 2 Moorfields Eye Hospital, 3 Department of Epidemiology and International Eye Health, Institute of Ophthalmology, 4 Department of Occupational and Environmental Medicine, Royal Brompton Hospital, and 5 Department of Clinical Ophthalmology, Institute of Ophthalmology, London, UK ABSTRACT Purpose: To assess the visual acuity outcome after treat- ment, in patients with differing types of uveitis associated with sarcoidosis, and to determine the types of sight- threatening complications. Methods: This was an retrospective, non-comparative, interventional study of patients who had uveitis with a confirmed diagnosis of sarcoidosis and a minimum follow- up duration of 6 months from presentation. The worst affected eye at presentation was selected for the study. Complications causing impaired vision were documented, changes in visual acuity after completion of treatment were measured, and the risk of ‘poor outcome’ (visual acuity 6/12 and less) was compared in the various types of uveitis, using ‘exact’ multiple logistic regression to control con- founding by other prognostic factors. Results: Seventy-five patients were studied. The spectrum of ocular inflammation in sarcoidosis is wide. Presentation may be acute and non-granulomatous or chronic and granulomatous with posterior segment involvement being varied. Poor visual outcome was significantly more frequent in multifocal choroiditis (5/7, 71.4%), and in panuveitis without multifocal choroiditis (13/28, 46.4%), compared to only 3/24 (12.5%) patients with anterior uveitis. The excess risks remained significant after adjustment for confounding effects of other prognostic factors including age, sex and manifest systemic sarcoidosis. Causes of visual loss were cataract, glaucoma, macular oedema, vitreous haemorrhage and retinal detachment. Conclusion: Multifocal choroiditis is a less common mani- festation of uveitis associated with sarcoidosis but appears to be associated with a worse visual prognosis despite immunosuppressive therapy. Key words: choroiditis, glaucoma, retinal vasculitis, sar- coidosis, uveitis. INTRODUCTION Sarcoidosis is one of the most common systemic disease associations with uveitis in the USA and Europe accounting for 3–7% of non-infectious uveitis cases. 1,2 Symptomatic ocular involvement is found during the clinical course of 20–30% of patients with sarcoidosis, 2,3 although higher proportions have been reported. 4 This is likely to be an underestimate as other studies have shown that not all involved eyes are symptomatic and are therefore only detected when sarcoidosis patients are screened for ophthal- mic involvement. 5–7 Sarcoidosis is associated with a wide spectrum of ocular inflammatory lesions involving the external eye and adnexae, as well as intraocular structures. Uveal tract inflammation occurs in over 70% of patients with ocular involvement and is the most frequently affected area, with the second being the lacrimal gland. 2,8 A variety of clinical patterns of inflam- matory disease have been described including isolated ante- rior uveitis, intermediate uveitis, panuveitis, peripheral retinal vasculitis, isolated or multifocal chorioretinal or retinal pigment epithelial lesions and optic nerve granulo- mata, or occasionally scleritis. Some of these lesions have the potential to cause sight-threatening complications espe- cially those associated with chronic anterior uveitis (cataract and glaucoma), 4,8 and chronic posterior segment disease (cataract, glaucoma, cystoid macular oedema, neovasculari- zation and optic nerve involvement). Posterior uveitis in association with chronic sarcoidosis has been reported to carry a poor visual prognosis although modern immuno- suppressive regimes may have improved this. 8 However, it is likely that in individual cases the degree of visual loss will depend on the particular type of lesion or combination of lesions that develop. The purpose of this study was to compare various types of uveitis in respect of visual outcome after the completion ■ Correspondence: Professor Susan Lightman, Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK. Email: s.lightman@ucl.ac.uk