Título

PRESUMED OCULAR SARCOIDOSIS PRESENTING AS RETINAL VASCULITIS AND PROLIFERATIVE RETINOPATHY: CASE REPORT

Objetivo

To describe a case of bilateral retinal vasculitis and proliferative retinopathy in a patient with presumed ocular sarcoidosis.

Relato do Caso

A 48-year-old woman complained about progressive bilateral vision loss over the last three years. No previous ocular surgeries or clinical treatments have been performed. The only comorbidity reported was systemic arterial hypertension. On the examination, the best-corrected visual acuity (BCVA) was 20/25 and 20/40 in her right (OD) and left eyes (OS), respectively. She had no remarkable findings on biomicroscopy. On fundus examination, microhemorrhages, abnormal vascular tortuosity, neovascularization, and vascular sheathing areas were observed in both eyes (Fig. 1A and 2A). OS also presented areas of fibrovascular proliferation near the superior temporal arcade (Fig. 2A). On fluorescein angiography, nonperfusion areas with perivascular leakage (Fig. 1B and 2B) were observed in both eyes, especially near the superior temporal arcade. Nonperfusion areas could be observed on optical coherence tomography (OCT) angiography (Fig. 1C and 2C), corresponding with thinning of the whole retina (Fig. 1D and 2D) and ganglion cell layer (Fig. 1E and 2E) on the macular thickness map. On OCT, thinning of the temporal parafoveal sector and outer plexiform layer elevations (Fig. 1F) could be seen in the OD, vitreous cells in OS, and attenuation of the interdigitation zone of the retinal pigment epithelium band in both eyes. Laboratory tests were normal. The PPD skin test was <1 mm, and the perfusion of the carotids on doppler-echography was normal. Finally, the chest radiography showed bilateral perilymphatic micronodules, suggesting sarcoidosis. Thus, a diagnosis of presumed ocular sarcoidosis was made, and the patient was referred to a combined treatment with anti-vascular endothelial growth injection, panretinal photocoagulation, and systemic immunosuppression.

Conclusão

Occlusive vasculitis associated with ocular sarcoidosis can lead to proliferative retinopathy without signs of anterior segment inflammation.