Treatment Approaches for Posterior Uveitis in Ocular Sarcoidosis: A Narrative Review.

Abstract

Purpose: To synthesise the current evidence on treatment strategies for posterior uveitis associated with ocular sarcoidosis.

Methods: A structured narrative review was undertaken, incorporating sarcoidosis-specific cohort studies, registry analyses, and clinically informative case series. Posterior ocular sarcoidosis was classified into distinct clinical phenotypes, including choroidal nodules and granulomas, retinal vasculitis, optic nerve granuloma, panuveitis with posterior involvement, and inflammatory sequelae to facilitate a phenotype-based synthesis of treatment approaches.

Results: Posterior involvement in ocular sarcoidosis is characterised by chronic inflammation, frequent relapses, and a heightened risk of irreversible visual impairment. Systemic corticosteroids continue to form the cornerstone of initial therapy and remain effective for induction across disease phenotypes. However, sustained remission often necessitates the early introduction of steroid-sparing immunomodulatory therapy, particularly in bilateral, chronic, or recurrent disease. Methotrexate remains the most widely employed first-line immunomodulatory agent. In refractory disease, or among patients with corticosteroid dependence, tumour necrosis factor-α inhibitors such as adalimumab and infliximab have demonstrated significant efficacy in controlling inflammation while reducing steroid burden. Visual loss is frequently attributable to secondary complications, including cystoid macular oedema, retinal ischaemia, choroidal neovascularisation, and optic nerve involvement.

Conclusion: The management of posterior sarcoid uveitis requires an early, escalation-based therapeutic approach that integrates immunomodulatory therapy with timely biologic intervention in order to prevent structural complications and optimise long-term visual outcomes.