Sarcoid Uveitis Relapse High but Visual Prognosis Favorable

Finding reliable predictors of sarcoid uveitis relapse might play an important role in order to stratify patients who will or will not relapse. This approach could potentially lead to tailored follow-up or treatment strategies for patient subgroups at higher risk of relapse. Photo: Tammy Than, OD. Click image to enlarge. A more comprehensive understanding of the risk factors for sarcoid uveitis relapse and visual impairment would contribute to optimizing the management of this common uveitis type. Researchers in Lyon, France, assessed these factors in a large cohort of patients with sarcoid uveitis and determined that the presence at baseline of macular edema and persistent inflammation were statistically significant predictors of relapse. The median time to ocular relapse was 2.6 years, and roughly 75% of patients who relapsed had experienced their first uveitis relapse by the three-year mark.“The risk of developing a first uveitis relapse after three years is low, with roughly one quarter of first uveitic relapses occurring after this time. In addition, half of the relapses we observed were considered minor according to five criteria for classifying severity,” the researchers wrote in their paper. “This suggests that the majority of sarcoid uveitis relapses are of minor severity, which can be considered a marker of favorable prognosis.”This retrospective study, which was published in Ophthalmology, included 336 patients, of whom 61.9% were women. Median age at uveitis diagnosis was 52 years (range: 10 to 89 years). Median follow-up was 7.8 years. Sarcoidosis was histologically proven in 83.0% of patients.Ocular relapses occurred in 66.7% of patients. The median time to ocular relapse was 2.6 years. Shorter ocular RFS was associated with the presence of macular edema (hazard ratio; HR = 1.47) and persistent inflammation (HR = 1.68) at baseline. According to World Health Organization definitions, visual impairment was present in 6.5% of patients at the end of the follow-up. Visual impairment was mild in 3.7%, moderate in 1.9%, severe in 0.0% and 0.9% of patients were blind. The main causes of visual impairment were glaucoma in 45.0%, macular edema in 40.0% and epiretinal membrane in 30.0% of patients. Risk factors for shorter visual impairment-free survival could not be estimated due to the small number of events.The researchers proposed several reasons why relapses would occur more often in this subset of patients with more severe uveitis presentations. In particular, patients with uveitic macular edema have been shown to have higher vitreous concentrations of proinflammatory cytokines or cytokine receptors.“This could potentially explain why patients with macular edema tend to relapse more, considering their inflammation is more severe and presumably more difficult to control,” they wrote.The team did point out that their results could lack generalizability in Asian or American populations, as most of our patients were of Caucasian and African ethnicities. So, they did not account for the effect of treatments because our population was quite heterogeneous in terms of uveitis phenotypes.Click here for the journal source. Abramowicz S, Jacquot R, Siriphanh A, et al. Factors associated with ocular relapse and visual prognosis in sarcoid uveitis. Ophthalmology. October 31, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.