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.