Evaluation of characteristic ocular signs and systemic investigations in ocular sarcoidosis patients.

PURPOSE: To evaluate the diagnostic values of ocular signs and systemic investigations in ocular sarcoidosis, in a retrospective case-control study. METHODS: Subjects were 67 consecutive uveitis patients with biopsy-proven sarcoidosis and 111 control patients with other clinical uveitis entities. The predictive values analyzed were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The five ocular signs for ocular sarcoidosis are (1) mutton fat keratic precipitates and iris nodules; (2) nodules at the trabecular meshwork and tent-shaped peripheral anterior synechia; (3) snowball vitreous opacities; (4) nodular periphlebitis, and (5) multiple chorioretinal lesions (active or atrophic) in the peripheral fundus. In addition, the results of the following five systemic investigations were considered: (1) negative tuberculin skin test; (2) elevated serum angiotensin-converting enzyme; (3) elevated serum lysozyme; (4) elevated serum gamma-globulin; and (5) bilateral hilar lymphadenopathy on chest X-ray. RESULTS: The incidence of all ocular signs and positive results for the systemic investigations were significantly higher in sarcoidosis patients than in controls (P < 0.001). The presence of two or three of the five ocular signs were indicative of a positive finding in the diagnostic parameters. The presence of two positive results among the five systemic investigations showed values higher than 0.800 for all diagnostic parameters. CONCLUSIONS: Combinations of the specified ocular signs and the results of systemic investigations can be used for the diagnosis of ocular sarcoidosis.

Validation of international criteria for the diagnosis of ocular sarcoidosis proposed by the first international workshop on ocular sarcoidosis.

PURPOSE: To validate the international criteria for the diagnosis of ocular sarcoidosis as proposed by the First International Workshop on Ocular Sarcoidosis (FIWOS). METHODS: A retrospective case-control study examined 370 consecutive uveitis patients at Tokyo Medical and Dental University Hospital. The study group consisted of 50 patients with biopsy-proven sarcoidosis and 320 control patients with other uveitis entities. Predictive values [sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)] were calculated for seven clinical signs, five laboratory tests, and the diagnostic criteria. RESULTS: With the exception of the liver enzyme tests, there was a significantly higher incidence of positive results for all clinical signs and laboratory tests in the biopsy-proven sarcoidosis patients than in the control uveitis patients. Although variability was noted in the predictive values of the seven clinical signs and five laboratory tests, the sensitivity, specificity, PPV, and NPV of the FIWOS criteria, which were based on the combined results of the clinical signs and laboratory tests, were 1.000, 0.956, 0.781, and 1.000, respectively. CONCLUSIONS: The FIWOS criteria have high predictive values for diagnosing ocular sarcoidosis. To further confirm these findings, an international prospective multicenter study should be undertaken in the future.