[Sarcoidosis-associated uveitis: Current status and future prospects].

Abstract

Sarcoidosis-related uveitis is the most common manifestation of ocular sarcoidosis. It can occur at any age but preferentially affects adults aged 30 to 60 years, with a female predominance, especially in forms with late onset. Suggestive semiological features are: granulomatous anterior uveitis defined by thick retro-descemetal precipitates (so-called "mutton-fat" keratic precipitates) or iris nodules, anterior synechiae, vitreous inflammation (hyalitis), periphlebitis, choroidal granulomas, and macular edema. Diagnosis relies on a combination of these ophthalmological features and paraclinical tests, notably serum biomarkers and suggestive chest imaging. Management is guided by the anatomical characteristics of the uveitis - including laterality and the severity of inflammation - as well as associated extra-ophthalmic manifestations and the patient's background. Systemic treatment is offered in case of failure, contraindication or side effects of local corticosteroid therapy, or active bilateral posterior-segment involvement. Conventional immunosuppressive agents, particularly methotrexate, remain first-line therapy. Hydroxychloroquine appears to be a good option for anterior and intermediate uveitis. Biologic agents such as anti-TNFα drugs - especially adalimumab - are used for refractory cases because of their steroid-sparing effect demonstrated for chronic non-anterior non-infectious uveitis. Tocilizumab appears to be an alternative to anti-TNF agents, particularly in patients with macular edema. Multi-omics techniques and artificial intelligence offer prospects for diagnosis, refining prognosis and personalizing therapy for sarcoid uveitis.