Treatment of ocular sarcoidosis. study of 65 patients of a series of 384 patients from a single university hospital

Background: Ocular involvement is a relatively frequent and potentially severe complication of sarcoidosis. Oral corticosteroids (OCS) are the first-line treatment. Conventional immunosuppressive agents (cIS) and biological therapy (BT) can be used in refractory cases (1-5). Objectives: To evaluate the treatment and visual outcomes of a cohort of patients diagnosed with ocular sarcoidosis. Methods: Study of a large cohort (n=384) of all consecutive patients diagnosed with sarcoidosis from January 1, 1999 to December 31, 2019 at a single University Hospital. Finally, 344 patients were included according the ATS/ERS/WASOG criteria (Eur Respir J. 1999; 14:735-7). Different ocular manifestations and the following systemic treatments were assessed: a ) OCS, b ) cIS), c ) monoclonal TNF inhibitors, d ) Etanercept (ETN), e ) Tocilizumab (TCZ). Best Corrected Visual Acuity (BCVA) according to different systemic treatments was compared at diagnosis and after one year of follow-up (Kruskall Wallis test). Results: 344 patients were reviewed. From these, 65 (18.9%) presented ocular manifestations as uveitis (83.1%), orbital lesions (7.7%), retinal vasculitis (6.2%), dry eye (6.2%) and scleritis (1.5%). All of them received systemic treatment. BT was particularly used in patients with retinal vasculitis (100%), panuveitis (75%) and orbital lesions (40%). Systemic treatment and BCVA outcome according to ocular manifestations are shown in table. Median BCVA at onset and after one year was 0.6 [interquartile range (IQR) 0.3-0.8] and 0.9 [0.6-1], respectively. No statistically significant differences were observed between systemic treatments in BCVA of patients with uveitis after 1 year of follow-up (Figure). Figure 1. Median [25,75 IQR] BVCA after one year follow up according to type of systemic treatment in sarcoid uveitis. Median BCVA after one year Systemic treatment Abbreviations: BCVA: Best Corrected Visual Acuity; OCS: Oral Corticosteroids; Conventional IS: Conventional immunosupressants; Monoclonal TNFi: monoclonal tumour necrosis factor inhibitors; ETN: Etanercept; TCZ: Tocilizumab. Conclusion: Panuveitis, intermediate uveitis and orbital lesions, require a more aggressive treatment than other manifestations of ocular sarcoidosis. In uveitis, an important improvement in BCVA after 1 year of follow-up was observed regardless of the type of treatment used. References: [1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum 2015;45(3):361-8. PMID: 26092330 [2]Riancho-Zarrabeitia L et al. Clin Exp Rheumatol 2014;32(2):275-84. PMID: 24321604 [3]Vegas-Revenga N, et al. Am J Ophthalmol 2019; 200:85-94. PMID: 30660771 [4]Cordero-Coma et al. Mediators Inflamm 2014; 2014:717598. PMID: 24976689 [5]Calvo-Río V, et al. Clin Exp Rheumatol 2014; 32 (4 Suppl 84): S54-7. PMID: 25005576 Table 1. Median BCVA at onset and after one year according to ocular manifestations and type of systemic therapy. Type of ocular affectation n (% ) Median BCVA at onset [IQR] Median BCVA after 1 year [IQR] OCS n (% ) cIS n (% ) monoclonal TNFi n (% ) ETN n (% ) TCZ n (% ) Uveitis 54 (83.1) 0.6 [0.3-0.8] 0.9 [0.6-1] 44 (81.5) 29 (53.7) 16 (29.6) 3 (5.5) 3 (5.5) - Anterior 31 (47.7) 0.7 [0.3-0.8] 0.8 [0.5-1] 22 (70.9) 12 (38.7) 2 (6.5) 2 (6.5) 0 - Intermediate 2 (3.1) 0.5 0.7 2 (100) 1 (50) 1 (50) 1 (50) 1 (50) - Posterior 5 (5.2) 0.5 [0.1-0.9] 0.9 [0.9-1] 4 (80) 4 (80) 3 (60) 0 0 - Panuveitis 16 (24.6) 0.4 [0.2-0.7] 0.9 [0.5-1] 16 (100) 12 (75) 10 (62.5) 0 2 (12.5) Orbital lesions 5 (7.7) 0.5 [0.1-0.6] 1 [0.1-1] 4 (80) 2 (40) 2 (40) 0 1 (20) Retinal vasculitis 4 (6.2) 0.6 [0.5-0.8] 1 [0.6-1] 4 (100) 4 (100) 1 (25) 0 1 (25) Dry eye 4 (6.2) 1 0.9 2 (50) 1 (25) 0 0 0 Scleritis 1 (1.5) 1 1 1 (100) 0 0 0 0 Abbreviations: BCVA: Best Corrected Visual Acuity; IQR: Interquartile Range; OCS: Oral Corticosteroid; cIS: Conventional Immunosuppressants; Monoclonal TNFi: monoclonal tumour necrosis factor inhibitors; ETN: Etanercept; TCZ: Tocilizumab. Disclosure of Interests: Carmen Álvarez-Reguera: None declared, Jorge Javier Gaitán-Valdizán: None declared, Raúl Fernández-Ramón: None declared, Rosalía Demetrio-Pablo: None declared, José Luis Martín-Varillas: None declared, Lara Sanchez-Bilbao: None declared, David Martínez-López: None declared, Iñigo González-Mazón: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi and MSD., Grant/research support from: Abbvie, MSD, Janssen and Roche., Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: Abbvie, MSD and Roche.