Choroidal granulomas in systemic sarcoidosis

Purpose: To evaluate the clinical: course, including response to therapy, o f patients with macular-and peripapillary choroidal granulomas secondary to systemic sarcoidosis. Methods: This is a retrospective case study and literature review. Nine pat ients with choroidal granulomas were identified. Eight patients had; a tiss ue biopsy confirming sarcoidosis; one was diagnosed; from clinical history and typical gallium scan, Ocular examinations included fundus examination, fluorescein angiography, and visual field examination. Eight patients had m agnetic resonance imaging (MRI) scans looking for intracranial granulomas. Treatment consisted of oral prednisone in eight patients tone with concomit ant subconjunctival triamcinolone); one patient received no treatment becau se of good vision and granuloma in the nasal retina: Variables studied incl uded: visual acuity (VA), response of granulomas: to treatment, time to rec urrence, and associated, anterior segment findings. Results: Eight of nine patients had a solitary lesion whereas one had multi focal involvement. The granulomas ranged in size from one half to four disk diameters. Eight patients had blurry vision; one was asymptomatic. All nin e patients had hilar adenopathy and/or pulmonary parenchymal: disease. No p atient had nonocular neurologic symptoms and in eight patients who underwen t MRI examination no intracranial granulomas were detected. Of the eyes tha t were treated (n = 8) all had decrease in the size of the choroidal mass a t an average of 4 months of treatment. Two had complete resolution. Mean fo llow-up was 29.2 months. At the time: of initial diagnosis only one patient had an active anterior uveitis. Five of nine patients had at least one rec urrence. Mean time to recurrence was 7.6 months after discontinuing oral pr ednisone. The VA at presentation ranged from 20/30 to 20/300. Final VA: was 20/30 or better in all patients. Conclusions: Choroidal granulomas related to systemic sarcoidosis respond w ell to oral corticosteroids. They may recur but good vision can be maintain ed. They are not. typically associated with concomitant iritis and also do not appear to be associated with intracranial granulomas.