Differences in Clinical Findings between Caucasians and African Americans with Biopsy-Proven Sarcoidosis

doi:10.1016/j.ophtha.2006.05.074

Ophthalmology

Volume 114, Issue 2, February 2007, Pages 325-333.e1

Presented in part at: American Academy of Ophthalmology Annual Meeting, October 2004, New Orleans, Louisiana.

https://doi.org/10.1016/j.ophtha.2006.05.074 Get rights and content

Objective

To study the prevalence of ocular manifestations in African American and Caucasian patients with biopsy-proven sarcoidosis at the initial ophthalmic examination and to determine the relationship between angiotensin-converting enzyme (ACE) levels, chest x-ray findings, and ocular signs of sarcoidosis.

Design

Retrospective, cross-sectional, observational study.

Participants

Eighty-one consecutive patients with biopsy-proven sarcoidosis seen at the Doheny Eye Institute from January 1989 through April 2005.

Methods

Medical records were reviewed to obtain demographic data, biopsy site, initial ocular findings, pulmonary symptoms, and results of serum ACE levels and chest x-rays. Associations between ACE level/chest x-ray stages and ocular manifestations related to sarcoidosis were obtained from these data.

Main Outcome Measures

Ocular manifestations related to sarcoidosis.

Results

Of the 81 patients, 35 were Caucasian; 29 were African American; and the remaining 17 were Hispanic, Asian Indian, and other races. Female patients were older than males (P = 0.05). Sixty-five (80%) of the 81 patients had ocular manifestations related to sarcoidosis. Thirty-three patients (40.7%) had uveitis, 12 (14.8%) had adnexal granulomas, and 25 (30.8%) had keratoconjunctivitis sicca. Of the 33 patients with uveitis, 22 presented with nongranulomatous inflammation. There was no significant association between ocular manifestations related to sarcoidosis and serum ACE levels (P = 0.43) or chest x-ray stage (P>0.99). Of the 29 African American patients, 26 (89.7%) had ocular manifestations related to sarcoidosis, compared with 24 (68.6%) of the 35 Caucasians (P = 0.12). The African American patients were younger (mean age, 44.4 years) than the Caucasian patients (mean age, 52.0) (P = 0.003) and had higher mean ACE levels (P = 0.003). A significantly high proportion of African American males presented with uveitis (P = 0.005), and a significantly high proportion of African American females presented with adnexal granulomas (P = 0.05).

Conclusions

The present study reveals that patients with sarcoidosis can present initially with clinical features of nongranulomatous uveitis. Relative to Caucasians, African American patients with sarcoidosis tend to be younger when they first present to the ophthalmologist and to present with uveitis and/or adnexal granuloma. Serum ACE levels and chest x-ray stages may not help predict the occurrence of ocular changes in sarcoidosis.

Section snippets

Materials and Methods

After obtaining approval from the institutional review board of the University of Southern California, we conducted a retrospective, cross-sectional, observational study using the medical records of 81 patients with biopsy-proven sarcoidosis who were seen at Doheny Eye Institute from January 1989 through April 2005. All cases were identified by a search of the computerized billing records. All patients were referred by either a general ophthalmologist (44 patients) or a pulmonologist (37

Results

There were 81 patients; 21 (25.9%) were male and 60 (74.1%) female. Their ages ranged from 23 to 70 years, with the median being 50 and the mean 48.8. The majority of patients were either Caucasian (43.2%) or African American (35.8%) (Table 1). The most common biopsy sites were lung and lymph node (Table 1). The biopsy site was unspecified in 20 patients.

Chronic systemic sarcoidosis has been defined as disease of ≥2 years’ duration.⁵ On initial presentation at the Doheny Eye Institute, 45

Discussion

The presence of typical granulomatous uveitis in patients with high serum ACE levels may suggest a diagnosis of sarcoidosis21, 22, 23; however, definitive diagnosis requires a biopsy revealing the typical histologic findings of noncaseating granulomas. In the past, the Kveim test was used to support the diagnosis of sarcoidosis,⁵ but the Kveim test is no longer used because it is negative in approximately 20% of patients with acute disease and gradually becomes negative in over 90% of

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: Manuscript no. 2005-1059.

: Supported in part by National Institutes of Health, Bethesda, Maryland (grant no.: EY03040).

: The authors have no proprietary or financial interest in any products or techniques described in the article.

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Original ArticleDifferences in Clinical Findings between Caucasians and African Americans with Biopsy-Proven Sarcoidosis

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Am J Med

Am J Ophthalmol

Br J Dis Chest

Am J Ophthalmol

Am J Med

Ophthalmology

Eur J Intern Med

Ophthalmology

Lancet

Transbronchial lung biopsy in the diagnosis of suspected ocular sarcoidosis

Arch Ophthalmol

Ocular sarcoidosis

Br J Ophthalmol

Ocular sarcoidosis

Trans Ophthalmol Soc U K

Clinical course of ocular sarcoidosis in patients with histologically proven systemic sarcoidosis [in French]

J Fr Ophtalmol

Incidence of ocular manifestations in patients with histologically confirmed systemic sarcoidosis [in German]

Klin Monatsbl Augenheilkd

Risk factors for ocular sarcoidosis

Doc Ophthalmol

Original Article
Differences in Clinical Findings between Caucasians and African Americans with Biopsy-Proven Sarcoidosis