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Okuläre Sarkoidose

Ocular sarcoidosis

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Zusammenfassung

Eine Augenbeteiligung bei Sarkoidose tritt mit einer Prävalenz bis zu 60 % bei bekannter systemischer Sarkoidose auf und zählt zu den häufigsten Formen der nichtinfektiösen Uveitis. Bei bekannter pulmonaler Sarkoidose tritt eine Augenbeteiligung in bis zu 80 % der Fälle auf. Die Sarkoidose kann sich auch ohne Systemmanifestation nur am Auge zeigen (okuläre Sarkoidose). Typischerweise tritt die okuläre Sarkoidose in Form einer bilateralen granulomatösen Uveitis auf und kann alle Augenabschnitte betreffen. Neben der akuten anterioren Uveitis findet sich häufig eine chronische intermediäre oder posteriore Uveitis. Um eine schwerwiegende Sehbeeinträchtigung bis zur Erblindung zu verhindern, kommt der rechtzeitigen Diagnosestellung und Therapie eine große Bedeutung zu. Zur Diagnosestellung ist die Kombination aus typischen klinischen Zeichen am Auge (beidseitige granulomatöse Veränderungen in allen Augenabschnitten) und typischen Laborparametern (ACE, Lysozym, sIL2R, Thoraxröntgenaufnahme oder Thorax-CT) heranzuziehen, da eine Biopsie mit dem Nachweis nicht verkäsender Granulome zur Diagnosesicherung bei rein auf das Auge beschränkten Veränderungen aufgrund eines hohen Risikos nicht durchgeführt wird. Therapeutisch ist die okuläre Sarkoidose einer Therapie mit lokalen oder systemischen Kortikosteroiden meist gut zugänglich. Bei unzureichendem Ansprechen können immunsuppressive Basistherapeutika und Biologika eingesetzt werden.

Abstract

Ocular manifestation of sarcoidosis occurs in up to 60% of patients with confirmed systemic sarcoidosis and represents one of the most common forms of noninfectious uveitis. In known pulmonary sarcoidosis, ocular involvement can occur in up to 80% of cases. Sarcoidosis can also present only in the eye, without a systemic manifestation (ocular sarcoidosis). Typically, ocular sarcoidosis shows bilateral granulomatous uveitis and can involve all parts of the eye. Apart from an acute anterior uveitis, chronic intermediate or posterior uveitis can be found. In order to prevent a severe reduction of visual acuity leading to blindness, early diagnosis and treatment is essential. For diagnosis, specific clinical signs involving the eye (bilateral granulomatous changes in all parts of the eye) and typical laboratory investigations (angiotensin-converting enzyme, ACE; lysozyme; soluble interleukin 2 receptor, sIL2R; chest X‑ray; chest CT) have to be taken into account, since biopsy to prove noncaseating granulomas is not performed with changes restricted to the eye due to the high risk of vision loss. Ocular sarcoidosis mostly responds well to local or systemic steroid treatment. If the therapeutic effect is insufficient, immunosuppressive agents and biologics can be applied.

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Authors and Affiliations

  1. Augenklinik, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063, Ludwigshafen, Deutschland

    C. Springer-Wanner & T. Brauns

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  1. C. Springer-Wanner
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  2. T. Brauns
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Correspondence to C. Springer-Wanner.

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C. Springer-Wanner und T. Brauns geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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P. Korsten, Göttingen

R. Bergner, Ludwigshafen

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Springer-Wanner, C., Brauns, T. Okuläre Sarkoidose. Z Rheumatol 76, 391–397 (2017). https://doi.org/10.1007/s00393-017-0303-7

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