NON-CASEATING CONJUNCTIVAL GRANULOMAS IN PATIENTS WITH MULTIFOCAL CHOROIDITIS AND PANUVEITIS

Purpose: This study describes a group of patients with clinical findin gs of peripheral punched-out lesions and panuveitis who had non-caseat ing granulomas found by nondirected conjunctival biopsy. Methods: A se ries of 10 patients seen at The University of Iowa Hospitals and Clini cs between August 1989 and August 1990 with ocular findings similar to those of multifocal choroiditis with panuveitis, including peripheral punched-out chorioretinal lesions, vitritis, and frequently, cystoid macular edema, was examined. All patients underwent ophthalmic examina tion, ancillary testing, and non-directed conjunctival biopsy. Results : Of the ten patients, nine were women. Results of FTA-ABS were negati ve for all patients. A non-directed conjunctival biopsy disclosed non- caseating granulomata in seven of the patients. Acid-fast bacilli were not detected in any specimens. Four of the seven patients with positi ve biopsy results had either elevated serum angiotensin-converting enz yme levels or chest x-rays consistent with sarcoid. Six of these seven patients were 58 years of age or older. Conclusion: It is recommended that non-directed conjunctival biopsy specimens be examined to exclud e the presence of non-caseating granulomata in uveitis patients with s mall, inferior, peripheral, punched-out chorioretinal scars, especiall y in women older than 55 years of age.