Diffuse Berlin nodules: unusual presentation of ocular sarcoidosis.
Diffuse Berlin nodules: unusual presentation of ocular sarcoidosis.
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弥漫性柏林结节：眼部结节病的异常表现。
DOI：
10.1136/bjophthalmol-2013-303112
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Sun,Yang
中科院分区：
文献类型：
--
作者：
Kassa,Enoch;Elner,VictorM;Moroi,SayokoE;Sun,Yang
An adult patient was sent to Kellogg Eye Center by an optometrist for a 3-month history of gradual blurry vision in the right eye. The optometrist reported abnormalities during slit-lamp examination in the right eye. The left eye was unaffected. The patient denied pain in either eye. The patient is overall healthy without any pertinent past medical or surgical history. On examination, visual acuity was 20/40 in the affected eye and 20/25 in the left eye. General physical exam was otherwise unremarkable. Pupillary examination showed a mild afferent pupillary defect in the right eye.Schirmer I test was within normal limits with 15 mm in right eye and 14 mm in left eye. Intraocular pressure (IOP) was elevated to 34mmHg in the right eye while the left eye was normal with 16 mm Hg. Whitish nodules were observed against the peripheral cornea by slit-lamp examination (figure 1A, arrow). More nodules were visible in the anterior chamber angle by gonioscopy (figure 1B, arrowhead) with superficial fine vessels; peripheral anterior synechiae (PAS) was not observed. Dilated fundoscopic examination was normal and examination of the tarsal conjunctiva did not reveal granuloma formation. Imaging and laboratory studies including CBC, chest x-ray, RPR/VDRL, antitreponemal antibody test, ACE levels, lysozyme levels and CT of orbit were all negative. The patient was then scheduled for a biopsy of the ocular lesions. Biopsy was performed and the specimen was sent to the pathology laboratory. Pathology report identified non-granulomatous giant-cells consistent with sarcoidosis (figure 2). The patient was treated with topical corticosteroids and followed up weekly for several weeks until vision and IOP returned to within normal levels.
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