Department of Opthalmology, Te Whatu Ora Southern, Dunedin, New Zealand.
Otago School of Medicine, University of Otago, Dunedin, New Zealand.
Clin Exp Ophthalmol. 2024 Apr;52(3):294-316. doi: 10.1111/ceo.14366. Epub 2024 Feb 22.
Sarcoidosis is a leading cause of non-infectious uveitis that commonly affects middle-aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non-caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid-sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.
结节病是一种常见于中年人群的非感染性葡萄膜炎的主要病因,且女性居多。该疾病的临床表现存在年龄、性别和种族差异。结节病的诊断基于临床表现一致、支持性检查以及非干酪样肉芽肿的组织学证据,尽管并非总是可行进行活检。宽视野眼底照相、光学相干断层扫描和血管造影等多模态成像有助于诊断结节病性葡萄膜炎,并监测治疗反应。皮质类固醇仍然是治疗的主要手段;慢性炎症需要类固醇保存的免疫抑制。多模态成像上的特征,如血管渗漏,可能提供预后的指标。女性、长时间和严重的葡萄膜炎以及累及后葡萄膜的葡萄膜炎与较差的视力预后相关。