Sarcoid uveitis in Chinese

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????????Uveitis with Biopsy-proven Sarcoidosis ??? Yu-Mei Chung

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Sarcoidosis A multisystemic granulomatous disease of unknown origin, characterized by widespread non-caseating epithelioid cell granuloma Major organs involved are the chest, skin, eye & etc Uveitis is the most common ocular manifestation Diagnosis based on the presence of non-caseating granuloma on tissue biopsy along with compatible uveitis

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Epidemiology of Sarcoidosis(prevalence/per 105) American blacks : 35.5 Caucasian : 10.9 Japan: 4.5 Taiwan: 1

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Sarcoidosis reported in Taiwan * Perng RP et al. 38 pts in 1960-1995 ??????? * Hsieh CW et al. 56 pts in 1985-2004 ????????? * Chao et al. 12 pts in 1988-1998 ????? * Chung YM et al. 60 pts in 1986-2005 ???????

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Number of Presence of Sarcoid Uveitis by Year (1986-2005) (year)

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Initial symptoms of 60 patients with biopsy- proven sarcoid uveitis

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age and sex distribution of uveitis onset among 60 patients

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Uveitis in Sarcoidosis Granulomatous or Non-granulomatous Anterior Uveitis mutton-fat KPs, prism sign, iris nodule, PAS, PS,AAU… Intermediate Uveitis snow ball, snow bank… Posterior Uveitis retinitis, retinal periphlebitis, candle-wax dripping, choroidal nodule, choroidal granuloma… Panuveitis

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Non-granulomatous AAU in Sarcoid Uveitis

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Non-granulomatous AAU in Sarcoid Uveitis

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Prism sign, ??XX, 2006-11-23(inferior thickening of cornea due to endothelial dysfunction by KPs)

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Sarcoid uveitis with snowball Miss Lee, 51 y/o

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Snowballs in scarcoid uveitis, Miss ? 49 y/o

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Snow bank in Sarcoid Uveitis, Miss Lin, 29y/o

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360o Snowbank in Sarcoid Uveitis Mr. Kao 64 y/o

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Retinitis in Sarcoid Uveitis Miss Lee 51 y/o

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Candle-wax dripping vasculitis

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Nodular Vasculitis in Sarcoid Uveitis

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Miss ?, 50 y/o Hemorrhagic Retinopathy in Sarcoid Uveitis

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Choroidal nodules in sarcoid uveitis Miss Hsiu 55 y/o

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Choroidal nodules in Sarcoid Uveitis

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Choroidal Nodule in Sarcoidosis

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Epiretinal membrane in sarcodi uveitis, Miss Lin 50 y/o

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Large granuloma involving optic disc Miss ?,55y/o

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Choriodal granuloma, Miss Chen 21 y/o

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Manifestations of Uveitis

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Frequency of ocular signs(anterior segment)

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Frequency of ocular signs(intermediate segment)

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Frequency of ocular signs(posterior segment)

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Frequency of ocular signs(posterior segment)

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Multiple manifestations can present simultaneously in sarcoid uveitis

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Putative mechanisms of the fundus changes in Sarcoid Uveitis Epiretinal membrane Multiple choroiditis Retinal vasculitis Retinitis Fibroglial tissue proliferation Cells in vitreous Large granuloma Snow balls Snow bank Chronic & Granulomatous Inflammation Acute & Nongranulomatous Inflammation

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Course (by SUN*) and Treatment

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Visual acuity at the initial & last visits

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Tissue proof sites Mediastinum lymph node: 34 Lung: 14 Conjunctiva: 13 Skin: 10 Extrathoracic lymph node: 6 Liver:1 Spleen:1 Bone marrow:1 Parotid gland:1

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Comparisons of Chest Condition in stages of CXR and CT of the chest (N=44) # CT: Computed tomography *CXR: chest x-ray film

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Appearance of Conjunctiva in Sarcoidosis Crick et al. : follicle, chalky deposits Karcioglu et al. : millet-seed nodule Hunter et al. : younger than 35 y/o Nussenblatt. : granuloma O’Connor & Smith. : nodule Karma. : nodules Chung. : nearly normal, postive rate :1/3

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Conclusions 60 Chinese patients with tissue-proven sarcoidosis, during 20 years(1986 to 2005) 3/4 found in the recent 4 years Female predominence (male:female=1:6) The fifth decade is the most common onset age Posterior segment is the most common involved area Chest CT is useful to discover chest lesion Conjunctiva biopsy is suggested

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