Presumed sarcoid choroiditis: referral pathways, demographic characteristics and disease phenotypes.

Abstract Purpose: To audit the current clinical process whereby patients with presumed sarcoid choroiditis are referred for systemic investigation. To describe demographic and phenotypic heterogeneity of patients clinically diagnosed with presumed sarcoid choroiditis, and to compare between those who were concordant and non-concordant to the 2019 International Workshop on Ocular Sarcoidosis (IWOS) diagnostic criteria. Method: Retrospective audit of patients clinically diagnosed with presumed sarcoid choroiditis evidenced by the presence of hypo-fluorescent dark dots (HDDs) on indocyanine green angiography (ICGA). Cases with serologic evidence of tuberculosis were excluded. A target of six months was set between diagnosis and referral to a sarcoidosis clinic. Demographic data, intra-ocular clinical signs, and systemic investigations—as outlined by IWOS criteria—were analysed and compared between IWOS-concordant and IWOS-non-concordant groups. Results Sixty-one cases of suspected sarcoid choroiditis based on clinical diagnosis plus HDDs on ICGA and negative serological tests for tuberculosis were included. Following referral, 34.4% of patients were systemically investigated by a sarcoidosis specialist within six months. Mean age was 46.6±17.1 years, 54.1% were male, and 44.3% Caucasian. Seventy-two percent (72%) of eyes fulfilled IWOS diagnostic criteria, while 28% did not Patients who met IWOS criteria were significantly more likely to have a systemic diagnosis of sarcoidosis versus the IWOS non-concordant group (41.2% vs 0%, p=0.010). Conclusion Approximately one-third of patients with presumed sarcoid choroiditis were referred for systemic evaluation within 6 months. ICGA is a useful diagnostic tool in the diagnosis of sarcoid choroiditis. ICGA may help identify IWOS-non-concordant patients whose disease is confined to the eye.