A Case Report: Ocular Sarcoidosis Presenting as Proliferative Retinopathy—A Mimicker of Proliferative Diabetic Retinopathy and Other Proliferative Retinopathies

Ocular sarcoidosis is a granulomatous inflammatory disease that can affect various ocular structures and mimic other retinal vasculopathies. Proliferative retinopathy is an uncommon presentation. We report the case of a 53-year-old man who presented with progressive, painless bilateral vision loss over 8 months. Examination revealed bilateral retinal neovascularization and peripheral retinal non-perfusion, extensive 360° capillary non-perfusion from the equator to the retinal periphery seen on ultra-wide field fundus fluorescein angiography, and macular edema in the right eye. The patient also had an acute episode of bilateral anterior uveitis during his visits. Systemic evaluation showed chronic hepatitis B–related liver cirrhosis. Blood workup revealed elevated inflammatory markers and serum angiotensin-converting enzyme, with negative results for autoimmune and infectious workups. Chest X-ray results were normal. Using the International Workshop on Ocular Sarcoidosis criteria, a diagnosis of probable ocular sarcoidosis was made. He received three doses of intravitreal aflibercept in the right eye and three sessions of bilateral scatter laser photocoagulation to the nonperfused retina between September 2023 and January 2024. He demonstrated a favorable response to intravitreal anti-vascular endothelial growth factor injections, panretinal photocoagulation, and topical corticosteroids. Ocular sarcoidosis should be considered in cases of bilateral retinal neovascularization with nonperfusion and systemic inflammatory markers, especially when infectious and autoimmune causes have been ruled out.