Background/Purpose: Findings of ophthalmologic examination can guide the diagnostic management of uveitis. Granulomatous presentation is commonly associated with peculiar causes, including infections, eye-restricted diseases, or systemic diseases such as sarcoidosis, multiple sclerosis or bowel inflammatory diseases, but large series are lacking to confirm this trend. The present study aimed to evaluate relevance of granulomatous presentation for the etiological diagnosis of uveitis.

Methods: Single-centre retrospective study including patients referred from the Ophthalmology department to Internal Medicine practitioners for etiological diagnosis of uveitis. Uveitis related to pure ophthalmological diseases or occurring during the course of an already diagnosed pathology were excluded. Granulomatous presentation was defined by the aspect of keratic precipitates and/or the presence of iris nodules. Granulomatous uveitis were compared to non-granulomatous uveitis.

Results: One hundred and thirty-one consecutive granulomatous uveitis were compared to 120 non-granulomatous uveitis. Mains ophthalmologic findings (i.e. (bilateralism, topography, frequency of panuveitis, cystoid macular edema and chronicity)) were comparable between both subgroups. In contrast, vitreous snowballs were more frequent in granulomatous uveitis compared to non-granulomatous uveitis (32% vs. 21%, p=0.04). Increased serum angiotensin-converting enzyme titer, a positive latent tuberculosis test (purified protein derivative skin test or Interferon-gamma releasing assay) and chest CT scan findings were comparable between both groups. The frequency of lymphocytic alveolitis on bronchoalveolar lavage and granulomas on bronchial biopsies were also similar. At the end of the diagnostic workup which was comparable between groups, the rate of uveitis of undetermined origin was similar between both groups (35% vs. 32%, p=0.68), as well as the spectrum of causes: sarcoidosis (16% vs. 10%, p=0.19) and uveitis associated with latent tuberculosis (34% vs. 23%, p=0.09). In contrast, uveitis associated with HLA B27 antigen (6% vs. 0%, p=0.006) and Behçet’s disease (9% vs. 0%, p<0.001) were only observed in the non-granulomatous group. Rather than the granulomatous presentation of the anterior chamber, the combination of granulomatous uveitis with vitreous snowballs or with peripheral multifocal choroiditis was significantly associated with proven or presumed sarcoidosis (p=0.001 and p=0.006, respectively). Finally, response to treatment and relapse rate were comparable between both groups.

Conclusion: The granulomatous presentation of uveitis alone is not sufficient to guide the diagnostic management of uveitis and does not impact treatment response and outcome. In contrast, its association with vitreous snowballs or peripheral multifocal choroiditis are highly suggestive of sarcoidosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relevance-of-granulomatous-presentation-for-the-diagnosis-and-outcome-of-uveitis-retrospective-case-control-study-of-251-patients/