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Diagnostic and therapeutic evaluation of multiple choroidal granulomas in a patient with confirmed sarcoidosis using enhanced depth imaging optical coherence tomography

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, 236-0004, Japan

    Mami Ishihara, Etsuko Shibuya, Shin Tanaka & Nobuhisa Mizuki

Authors
  1. Mami Ishihara
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  2. Etsuko Shibuya
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  3. Shin Tanaka
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  4. Nobuhisa Mizuki
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Correspondence to Mami Ishihara.

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The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Ishihara, M., Shibuya, E., Tanaka, S. et al. Diagnostic and therapeutic evaluation of multiple choroidal granulomas in a patient with confirmed sarcoidosis using enhanced depth imaging optical coherence tomography. Int Ophthalmol 38, 2603–2608 (2018). https://doi.org/10.1007/s10792-017-0720-2

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  • DOI: https://doi.org/10.1007/s10792-017-0720-2

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