Diagnostic and therapeutic evaluation of multiple choroidal granulomas in a patient with confirmed sarcoidosis using enhanced depth imaging optical coherence tomography
- 109 Downloads
Sarcoidosis is a major cause of granulomatous uveitis but rarely manifests as multiple choroidal granulomas. This report describes the use of enhanced depth imaging optical coherence tomography (EDI-OCT) to visualize changes occurring in multiple choroidal granulomas during treatment.
The patient was a 36-year-old Japanese man with histopathologically confirmed sarcoidosis, who was examined using EDI-OCT and showed multiple yellowish-white subretinal lesions in the peripapillary region and the arcade of the right eye.
EDI-OCT revealed homogeneous hyporeflective choroidal lesions with choriocapillaris thinning, consistent with a diagnosis of choroidal granulomas. Subretinal fluid adjacent to one of the peripapillary choroidal lesions was also apparent. EDI-OCT during oral prednisolone administration revealed a decrease in lesion size at as early as 3 weeks and complete resolution of the lesions after 6 months of treatment. However, 2 months after prednisolone discontinuation, EDI-OCT revealed recurrence of choroidal granulomas in the peripapillary region and the arcade of the right eye. After injection of triamcinolone acetonide into the posterior sub-Tenon’s capsule (sub-Tenon’s injection), EDI-OCT demonstrated a reduction in granuloma lesion size within 3 months of the injection.
EDI-OCT allowed detailed morphologic visualization of the choroidal granulomas caused by sarcoidosis. This imaging technique was useful for monitoring changes in granuloma size in response to steroid administration and for early detection of recurrence. Injection of triamcinolone acetonide into the posterior sub-Tenon’s capsule was as effective as oral prednisolone for the treatment of choroidal granulomas.
KeywordsEDI-OCT Multiple choroidal granulomas Sarcoidosis Sub-Tenon’s injection
We thank Drs. S. Kawano, I. Kimura, T. Wakiya, T. Yamane, Y. Hasumi, M. Ishido, and Y. Ida for assisting in patient examination and treatment. The authors would like to thank Enago for the English language review.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Herbort CP, Rao NA, Mochizuki M, members of Scientific Committee of First International Workshop on Ocular Sarcoidosis (2009) International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop on Ocular Sarcoidosis (IWOS). Ocul Immunol Inflamm 17:160–169. doi: 10.1080/09273940902818861 CrossRefPubMedGoogle Scholar
- 16.Ohtsuka M, Hashida N, Hozumi K, Nishida K (2014) Diagnostic evaluation of sarcoid choroidal granuloma using high-penetration optical coherence tomography. J Jpn Ophthalmol Soc 118:1013–1019 [in Japanese] Google Scholar