Daley Jason R, Cherepanoff Svetlana, Heydon Peter G, Fung Adrian T
Liverpool Hospital, Sydney, NSW, Australia.
The University of Sydney, Sydney, NSW, Australia.
Int J Retina Vitreous. 2022 Sep 3;8(1):60. doi: 10.1186/s40942-022-00412-1.
To report a case of a subretinal, unilateral, peripapillary granuloma that was diagnosed as sarcoidosis by a 27-gauge pars plana vitrectomy subretinal biopsy. Sarcoidosis is a chronic idiopathic granulomatous inflammatory disease, that has ocular involvement in 10-80% of patients. It is often mistaken for many other primary ocular diseases because the condition can involve any structure in or around the eye. Previous case reports of peripapillary sarcoidosis have either been limited to the choroid or presented with additional ocular and systemic signs, hence have not required an intraocular biopsy.
A 54-year-old Filipino male presented with a 6-month history of painless blurred vision in his right eye. Fundus examination revealed a large white peripapillary lesion. Enhanced-depth imaging optical coherence tomography confirmed the subretinal location of the mass. Indocyanine green angiography demonstrated absolute hypofluorescent blockage with satellite lesions. A whole-body positron emission tomography scan demonstrated widespread lymphadenopathy, but investigations including an inguinal lymph node biopsy were inconclusive. Following growth of the peripapillary lesion and worsening vision, a 27-gauge pars plana vitrectomy subretinal biopsy was performed which confirmed sarcoidosis. He was treated with oral corticosteroids and transitioned to long term immunotherapy with methotrexate.
Sarcoidosis can present in the subretinal space, around the optic nerve without other ocular findings.
报告一例视网膜下、单侧、视乳头周围肉芽肿病例，该病例经27G经睫状体平坦部玻璃体切除视网膜下活检确诊为结节病。结节病是一种慢性特发性肉芽肿性炎症性疾病，10%-80%的患者有眼部受累。由于该疾病可累及眼内或眼周的任何结构，故常被误诊为许多其他原发性眼病。既往关于视乳头周围结节病的病例报告要么局限于脉络膜，要么伴有其他眼部和全身症状，因此无需进行眼内活检。
一名54岁的菲律宾男性，右眼出现无痛性视力模糊6个月。眼底检查发现视乳头周围有一个大的白色病变。增强深度成像光学相干断层扫描证实肿块位于视网膜下。吲哚菁绿血管造影显示有绝对的低荧光阻塞及卫星病灶。全身正电子发射断层扫描显示广泛的淋巴结病，但包括腹股沟淋巴结活检在内的检查结果不明确。视乳头周围病变增大且视力恶化后，进行了27G经睫状体平坦部玻璃体切除视网膜下活检，确诊为结节病。他接受了口服糖皮质激素治疗，并转为使用甲氨蝶呤进行长期免疫治疗。
结节病可出现在视网膜下间隙、视神经周围，而无其他眼部表现。
