Background/Purpose: Sarcoidosis(Sa) eye involvement is the most common extrapulmonary manifestation and the initial presentation in 5-20% of cases. The definitive diagnosis is histopathological. The sensitivity(S) of the conjunctival biopsy is low,so Ocular Sa(OSa) diagnostic criteria(C.) were proposed:IWOS(First International Workshop on Ocular Sarcoidosis),with high S and specificity(1/0.95), but they have been poorly validated. Our purpose was to apply the IWOS C., to analyze their consistency with the clinical diagnosis of OSa and to asses differential features between patients with OSa and those with systemic involvement

Methods: Cross-sectional study. Clinical records from patients with presumed Sa who had been followed for 10 years in a multidisciplinar Uveitis Unit (Ophthalmology/Rheumatology) were reviewed. Clinical variables and complementary tests results were analyzed. IWOS C. were applied if OSa was suspected. Chi-square test and Kappa coefficient were used

Results: 71 patients included: 47 OSa,13 with ocular-systemic involvement (OS-Sa) and 11 with systemic involvement (SSa). Women/Men 57%/43%, mean follow-up time 9.42 years (±8.55), with no intergroup differences. Significant differences between patients with OSa vs. OS-Sa/SSa were observed: mean age at diagnosis (40.23 ±18.18 vs. 57.54 ±17.65/48.27 ±17 years,p=0.01); mean ESR(16.74 ±12.73 vs. 26.38± 15/19.4 ±31.55 mm/h, p=0.01); mean CRP(3.58 ±4.29 vs. 8.12 ±8.11/10.24 ±14.37 mg/L, p=0.03); CT abnormalities (16.6% vs. 90%/92%, p=0.001); positive biopsy(0% vs. 8/100%, p=0.002); general, joint, respiratory and skin symptoms (OSa 6-12% vs SSa 15-50%,p=0.002). ACE was increased in 74.6%, with a mean value of 71.98 ±33.59 U/L, no intergroup differences. Altered lacrimal scintigraphy was more often found in the OSa subset (26.7%) vs. OS-Sa/SSa (23.1%/0%), without statistical significance. Comparing OSa vs. OS-Sa patients, ocular involvement was as follows: anterior segment involvement 48% vs 61.5%, intermediate segment 21.3% vs. 15.4%, posterior segment 8.5% vs 0%, panuveitis 21.2% vs. 23.1%, p=0.001. If OSa,bilateral involvement was present in 60% of patients, unilateral involvement was more frecuent in OS-Sa (76%), p=0.06.There were no significant differences regarding uveitis’s presentation,course and number of crisis and specific intraocular findings. Applying IWOS Criteria and comparing OSa vs OS-Sa we can classify: Definite OSa 0% vs. 69.2%, Presumed OSa 23.4% vs. 7.7%, Probable OSa 14.9% vs. 15.4% and Possible OSa 2.1% vs. 0%; not fulfilling criteria:59.6% vs. 7.7%(p=0.001). The kappa coefficient between suspicion of OSa/OS-Sa and not fulfilling/fulfilling criteria was 0.30 (p=0.003)

Conclusion:  We could classify as Presumed vs. Probable Ocular Sarcoidosis in 25% vs. 15% of patients with suspicion but who hadn’t undergone a biopsy. We excluded the diagnosis in 60%. There wasn’t a good consistency between the suspected diagnosis/IWOS Criteria fulfillment. Ocular Sarcoidosis patients were younger and had lower ESR/CRP levels. Involvement of the anterior ocular segment was the most frequent one, bilateral in Ocular Sarcoidosis and unilateral in Ocular-Systemic Sa

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-eye-sarcoidosis-with-or-without-systemic-involvement-application-of-iwos-criteria-in-an-uveitis-unit/