Walscheid K, Tappeiner C, Heiligenhaus A
Augenabteilung, St. Franziskus-Hospital Münster.
Universitätsklinik für Augenheilkunde, Inselspital Bern, Schweiz.
Klin Monbl Augenheilkd. 2016 May;233(5):594-600. doi: 10.1055/s-0042-104063. Epub 2016 May 17.
Sarcoidosis is an inflammatory multi-organ disease of unknown pathogenesis, characterised by non-necrotising granulomata. Sarcoidosis predominantly manifests in the lung, but any other organ may be affected. Ocular involvement is present in about 25 to 50 % of patients. The most common ocular manifestation is uveitis, especially of the anterior eye segment. If ocular sarcoidosis is suspected, interdisciplinary assessment of the patient is mandatory, including laboratory tests, chest X-ray, assessment by a specialist in internal medicine and, ideally, histological evidence of granuloma formation in a tissue specimen. Other (infectious) causes of granulomatous inflammation need to be excluded, especially tuberculosis or syphilis. For the ophthalmological assessment, detection of granulomatous lesions is of particular importance, especially by visualising chorioretinal granuloma by fluorescein and indocyanin green angiography. Cystoid macular oedema and glaucoma are the most frequent complications limiting visual acuity. Corticosteroids, which can be administered either locally or systemically, are the mainstay of therapy. Depending on the clinical course and the development of ocular complications, systemic steroid-sparing immunosuppressive medication may be indicated.
结节病是一种发病机制不明的炎症性多器官疾病,其特征为非坏死性肉芽肿。结节病主要累及肺部,但其他任何器官都可能受累。约25%至50%的患者存在眼部受累。最常见的眼部表现是葡萄膜炎,尤其是眼前节葡萄膜炎。如果怀疑患有眼部结节病,对患者进行多学科评估是必不可少的,包括实验室检查、胸部X线检查、内科专家评估,理想情况下还包括组织标本中肉芽肿形成的组织学证据。需要排除肉芽肿性炎症的其他(感染性)病因,尤其是结核病或梅毒。对于眼科评估,检测肉芽肿性病变尤为重要,特别是通过荧光素和吲哚菁绿血管造影来观察脉络膜视网膜肉芽肿。黄斑囊样水肿和青光眼是限制视力的最常见并发症。可局部或全身使用的糖皮质激素是主要治疗方法。根据临床病程和眼部并发症的发展情况,可能需要使用全身性类固醇节省免疫抑制药物。