Factors Associated with Ocular Relapse and Visual Prognosis in Sarcoid Uveitis.

PURPOSE: To describe the factors associated with ocular relapse and visual prognosis in patients with sarcoid uveitis.

DESIGN

Multicentric, retrospective cohort study.

PARTICIPANTS

A total of 336 patients were included, of whom 208 (61.9%) were female. Median age at uveitis diagnosis was 52 years (range, 10-89 years).

METHODS

Ocular relapses and incident visual impairment were recorded over the entire duration of follow-up. Factors associated with ocular relapses and visual impairment were subsequently analyzed. Kaplan-Meier curves for ocular relapse-free survival (RFS) and visual impairment-free survival were constructed for selected variables. Cox proportional hazards model was then applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Statistical significance was set at the P < 0.05 level.

MAIN OUTCOME MEASURES: Time to ocular relapse and time to visual impairment.

RESULTS

Median follow-up was 7.8 years. Sarcoidosis was histologically proven in 279 patients (83.0%). Ocular relapses occurred in 224 patients (66.7%). The median time to ocular relapse was 2.6 years (interquartile range, 1.6-4.4). Shorter ocular RFS was associated with the presence of macular edema (HR, 1.47, 95% CI, 1.07-2.02, P = 0.020) and persistent inflammation (HR, 1.68, 95% CI, 1.17-2.40, P = 0.004) at baseline. According to World Health Organization definitions, visual impairment was present in 21 of 325 patients (6.5%) at the end of follow-up. Visual impairment was mild in 12 of 325 patients (3.7%), moderate in 6 of 325 patients (1.9%), and severe in 0 of 325 patients (0.0%), and 3 of 325 patients (0.9%) were blind. The main causes of visual impairment were glaucoma in 9 of 20 patients (45.0%), macular edema in 8 of 20 patients (40.0%), and epiretinal membrane in 6 of 20 patients (30.0%). Risk factors for shorter visual impairment-free survival could not be estimated because of the small number of events.

CONCLUSIONS

Sarcoid uveitis relapses in approximately two-thirds of patients, and relapses are associated with the presence of macular edema and persistent inflammation at baseline. Most patients with sarcoid uveitis maintain adequate usable vision, with approximately 6% becoming mildly, moderately, or severely visually impaired, and approximately 1% becoming blind after a median follow-up of 7.8 years.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.