Vitreous lavage fluid and bronchoalveolar lavage fluid have equal diagnostic value in sarcoidosis

Maruyama, Kouichi; Inaba, Tohru; Tamada, Tsutomu; Nakazawa, Toru

doi:10.1097/md.0000000000005531

Cited by 15 publications

(7 citation statements)

References 20 publications

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“… 1 In our previous study, we reported finding similar CD4/CD8 ratios between the vitreous and the bronchoalveolar lavage fluid in patients with sarcoidosis. 22 Therefore, these findings suggest that the CD4/CD8 ratio in the vitreous fluid has predictive value for diagnosing sarcoidosis. If a patient is suspected of having sarcoidosis based on vitreous sample examination, it is then necessary to perform further clinical observations and treatments.…”

Section: Discussionmentioning

confidence: 76%

Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study

Maruyama

Inaba

Sugita³

et al. 2017

BMJ Open

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PurposeTo determine the clinical relevance of vitreous biomarkers in patients with uveitis.DesignMulticentre, prospective, observational study.SettingUveitis outpatient clinics of two academic medical centres in Japan.Patient populationThis study included 234 eyes of 191 patients with various uveitis aetiologies: definitive sarcoidosis (61 eyes of 46 patients), suspected sarcoidosis (60 eyes of 45 patients), intraocular tumour (34 eyes of 27 patients), viral infection (20 eyes of 18 patients), non-sarcoidosis (16 eyes of 16 patients) and unknown aetiology (43 eyes of 39 patients).Observation procedureVitreous samples (taken by pars planta vitrectomy) were analysed with flow cytometry, cytology and multiplex PCR analysis.Main outcome measuresThe primary outcome measures were the diagnostic values of various biomarkers (T cells, B cells and pathogen DNA) in vitreous samples. The secondary outcome was visual acuity after vitrectomy.ResultsSarcoidosis showed higher CD4/CD8 or CD4+measurements than other aetiologies (p<0.01). In samples with viral infection, pathogen DNA was detected, and CD8+counts were higher than the other aetiologies (p<0.01). Eyes with tumour had higher CD19+(p<0.05). Non-sarcoidosis had lower CD4/CD8 than sarcoidosis, higher CD8+than sarcoidosis and lower CD19+than tumour (p<0.01). Unknown uveitis had lower CD4/CD8 than sarcoidosis (p<0.01), and higher CD4/CD8 than non-sarcoidosis, viral infection or tumour (p<0.001). Visual acuity improved after vitrectomy (p<0.001).ConclusionsUveitis aetiologies had distinct vitreous biomarker profiles, especially of infiltrating lymphocytes. Analyses of CD4/CD8 ratio, T-lymphocyte and B-lymphocyte subset, and pathogen DNA in vitreous samples have good safety profiles and high diagnostic value for uveitis classification.Trial registration numberUMIN000004980; Pre-results.

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Section: Discussionmentioning

confidence: 76%

Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study

Maruyama

Inaba

Sugita³

et al. 2017

BMJ Open

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“…100 Only one of these patients with a normal chest X-ray had a chest CT. Two studies reported that CD4 þ/CD8þ ratios of vitreous lymphocytes were significantly higher in sarcoid uveitis versus other forms of uveitis. 101,102 The sensitivity and specificity of the vitreous CD4 þ/CD8þ ratio were 100 and 96.3%, respectively, for the diagnosis of intraocular sarcoidosis, suggesting a diagnostic value comparable to that of the CD4 þ/CD8þ ratio in BAL fluid for pulmonary sarcoidosis. 101 However, measurement of the vitreous CD4 þ/CD8þ ratio is a challenging investigation and the majority of panel members involved in the revision of the IWOS criteria considered this test to be too invasive to be performed solely for the purpose of diagnosing ocular sarcoidosis.…”

Section: New Diagnostic Toolsmentioning

confidence: 96%

Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

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“…Vitreous CD4/CD8 ratio >3.5 has been shown to be comparable to CD4/CD8 ratio in bronchoalveolar lavage (BAL) fluid for pulmonary sarcoidosis 91,92 . Vitreous CD4/CD8 ratio has been shown to have a sensitivity of 100% and specificity of 96.3% 91,92 .…”

Section: Ocular Investigationsmentioning

confidence: 99%

Insights into the diagnosis and management of sarcoid uveitis: A review

Samalia,

Lim,

Niederer

2024

Clinical Exper Ophthalmology

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Sarcoidosis is a leading cause of non‐infectious uveitis that commonly affects middle‐aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non‐caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid‐sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.

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Vitreous lavage fluid and bronchoalveolar lavage fluid have equal diagnostic value in sarcoidosis

Cited by 15 publications

References 20 publications

Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study

Comprehensive analysis of vitreous specimens for uveitis classification: a prospective multicentre observational study

Ocular Sarcoidosis

Insights into the diagnosis and management of sarcoid uveitis: A review

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