RETINAL SARCOIDOSIS

Purpose: To describe multimodal imaging of intraretinal sarcoidosis. Methods: Case series and literature review. Patients were included if they had presumed or definite ocular sarcoidosis and optical coherence tomography (OCT) evidence of intraretinal lesions. Results: In total, 23 retinal lesions from six patients were included. All patients were female and Caucasian, with a mean age of 81 years (range 73–88 years). The lesions were ovoid in 20 of 23 (87%) and hyperreflective in 23 of 23 (100%) lesions on OCT. Retinal pigment epithelial atrophy was identified in 12 of 23 (52%) and retinal pigment epithelial elevation in 8 of 23 (35%) lesions. Of 13 retinal lesions that had a follow-up OCT post corticosteroid treatment, 7 (54%) completely resolved and 6 (46%) were smaller. The lesions were hyporeflective on near-infrared imaging (12/17, 71%), hypoautofluorescent (12/15, 80%), hyperfluorescent on fluorescein angiography (15/17, 88%), and hypofluorescent (12/17, 71%) on indocyanine green angiography. Literature review identified only five other studies describing nine lesions of intraretinal sarcoidosis confirmed on OCT. Conclusion: Ocular sarcoidosis can present with intraretinal lesions that are ovoid and hyperreflective on OCT, hyporeflective on near infrared, hypoautofluorescent, hyperfluorescent on fundus fluorescein angiography, and hypofluorescent or isofluorescent on indocyanine green angiography. New findings of retinal sarcoidosis include multimodal imaging characteristics, foveal involvement, associated photoreceptor or retinal pigment epithelial atrophy, and spontaneous resolution and recurrence. Identification of intraretinal sarcoid lesions can assist in diagnosis and should be considered for inclusion in future diagnostic criteria. Prompt treatment of macular lesions with corticosteroids is recommended to avoid photoreceptor or retinal pigment epithelial atrophy with permanent visual loss.