Ocular sarcoidosis : clinical experience and recent pathogenetic and therapeutic advancements

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Dammacco , R , Biswas , J , Kivelä , T T , Zito , F A , Leone , P , Mavilio , A , Sisto , D , Alessio , G & Dammacco , F 2020 , ' Ocular sarcoidosis : clinical experience and recent pathogenetic and therapeutic advancements ' , International Ophthalmology , vol. 40 , no. 12 , pp. 3453-3467 . https://doi.org/10.1007/s10792-020-01531-0

Title: Ocular sarcoidosis : clinical experience and recent pathogenetic and therapeutic advancements
Author: Dammacco, Rosanna; Biswas, Jyotirmay; Kivelä, Tero T.; Zito, Francesco Alfredo; Leone, Patrizia; Mavilio, Alberto; Sisto, Dario; Alessio, Giovanni; Dammacco, Franco
Other contributor: University of Helsinki, HUS Head and Neck Center



Date: 2020-12
Language: eng
Number of pages: 15
Belongs to series: International Ophthalmology
ISSN: 0165-5701
DOI: https://doi.org/10.1007/s10792-020-01531-0
URI: http://hdl.handle.net/10138/325954
Abstract: Purpose To describe the ocular manifestations in a cohort of patients with systemic sarcoidosis (SS). Recent advances in the pathophysiology, diagnosis, and therapy of SS are also discussed. Methods Data from 115 Italian patients diagnosed between 2005 and 2016 were retrospectively reviewed. All but the first 17 patients underwent a comprehensive ophthalmologic examination. The diagnosis was based on clinical features, the demonstration of non-caseating granulomas in biopsies from involved organs, and multiple imaging techniques. Data on broncho-alveolar lavage fluid analysis, calcemia, calciuria, serum angiotensin-converting enzyme levels and soluble interleukin-2 receptor levels were retrieved when available. Results Ocular involvement, detected in 33 patients (28.7%), was bilateral in 29 (87.9%) and the presenting feature in 13 (39.4%). Anterior uveitis was diagnosed in 12 patients (36.4%), Lofgren syndrome and uveoparotid fever in one patient each (3%), intermediate uveitis in 3 patients (9.1%), posterior uveitis in 7 (21.2%), and panuveitis in 9 (27.3%). First-line therapy consisted of corticosteroids, administered as eyedrops (10 patients), sub-Tenon's injections (1 patient), intravitreal implants (9 patients), or systemically (23 patients). Second-line therapy consisted of steroid-sparing immunosuppressants, including methotrexate (10 patients) and azathioprine (10 patients). Based on pathogenetic indications that tumor necrosis factor (TNF)-alpha is a central mediator of granuloma formation, adalimumab, targeting TNF-alpha, was employed in 6 patients as a third-line agent for severe/refractory chronic sarcoidosis. Conclusion Uveitis of protean type, onset, duration, and course remains the most frequent ocular manifestation of SS. Diagnostic and therapeutic advancements have remarkably improved the overall visual prognosis. An ophthalmologist should be a constant component in the multidisciplinary approach to the treatment of this often challenging but intriguing disease.
Subject: Angiotensin-converting enzyme
Bronchoalveolar lavage
Ocular sarcoidosis
T-lymphocyte
Uveitis
ANGIOTENSIN-CONVERTING ENZYME
DIAGNOSTIC MODALITIES
INVOLVEMENT
UVEITIS
COHORT
METHOTREXATE
LYSOZYME
FEATURES
UTILITY
TRIAL
3125 Otorhinolaryngology, ophthalmology
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