Evaluation of Characteristic Ocular Signs and Systemic Investigations in Ocular Sarcoidosis Patients

Abstract

Purpose To evaluate the diagnostic values of ocular signs and systemic investigations in ocular sarcoidosis, in a retrospective case–control study. Methods Subjects were 67 consecutive uveitis patients with biopsy-proven sarcoidosis and 111 control patients with other clinical uveitis entities. The predictive values analyzed were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The five ocular signs for ocular sarcoidosis are (1) mutton fat keratic precipitates and iris nodules; (2) nodules at the trabecular meshwork and tent-shaped peripheral anterior synechia; (3) snowball vitreous opacities; (4) nodular periphlebitis, and (5) multiple chorioretinal lesions (active or atrophic) in the peripheral fundus. In addition, the results of the following five systemic investigations were considered: (1) negative tuberculin skin test; (2) elevated serum angiotensin-converting enzyme; (3) elevated serum lysozyme; (4) elevated serum γ-globulin; and (5) bilateral hilar lymphadenopathy on chest X-ray. Results The incidence of all ocular signs and positive results for the systemic investigations were significantly higher in sarcoidosis patients than in controls ( P < 0.001). The presence of two or three of the five ocular signs were indicative of a positive finding in the diagnostic parameters. The presence of two positive results among the five systemic investigations showed values higher than 0.800 for all diagnostic parameters. Conclusions Combinations of the specified ocular signs and the results of systemic investigations can be used for the diagnosis of ocular sarcoidosis. Jpn J Ophthalmol 2007;51:121–126 © Japanese Ophthalmological Society 2007