Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis.
OBJECTIVE
To study the prevalence of ocular manifestations in African American and Caucasian patients with biopsy-proven sarcoidosis at the initial ophthalmic examination and to determine the relationship between angiotensin-converting enzyme (ACE) levels, chest x-ray findings, and ocular signs of sarcoidosis.


METHODS
Retrospective, cross-sectional, observational study.


METHODS
Eighty-one consecutive patients with biopsy-proven sarcoidosis seen at the Doheny Eye Institute from January 1989 through April 2005.


METHODS
Medical records were reviewed to obtain demographic data, biopsy site, initial ocular findings, pulmonary symptoms, and results of serum ACE levels and chest x-rays. Associations between ACE level/chest x-ray stages and ocular manifestations related to sarcoidosis were obtained from these data.


METHODS
Ocular manifestations related to sarcoidosis.


RESULTS
Of the 81 patients, 35 were Caucasian; 29 were African American; and the remaining 17 were Hispanic, Asian Indian, and other races. Female patients were older than males (P = 0.05). Sixty-five (80%) of the 81 patients had ocular manifestations related to sarcoidosis. Thirty-three patients (40.7%) had uveitis, 12 (14.8%) had adnexal granulomas, and 25 (30.8%) had keratoconjunctivitis sicca. Of the 33 patients with uveitis, 22 presented with nongranulomatous inflammation. There was no significant association between ocular manifestations related to sarcoidosis and serum ACE levels (P = 0.43) or chest x-ray stage (P>0.99). Of the 29 African American patients, 26 (89.7%) had ocular manifestations related to sarcoidosis, compared with 24 (68.6%) of the 35 Caucasians (P = 0.12). The African American patients were younger (mean age, 44.4 years) than the Caucasian patients (mean age, 52.0) (P = 0.003) and had higher mean ACE levels (P = 0.003). A significantly high proportion of African American males presented with uveitis (P = 0.005), and a significantly high proportion of African American females presented with adnexal granulomas (P = 0.05).


CONCLUSIONS
The present study reveals that patients with sarcoidosis can present initially with clinical features of nongranulomatous uveitis. Relative to Caucasians, African American patients with sarcoidosis tend to be younger when they first present to the ophthalmologist and to present with uveitis and/or adnexal granuloma. Serum ACE levels and chest x-ray stages may not help predict the occurrence of ocular changes in sarcoidosis.
Evans
Monica
M
Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Sharma
Om
O
LaBree
Laurie
L
Smith
Ronald E
RE
Rao
Narsing A
NA
D000328:Adult; D001741:Black or African American; D000368:Aged; D001706:Biopsy; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006099:Granuloma / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D015995:Prevalence; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D014605:Uveitis / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D044465:White People
D007703:Peptidyl-Dipeptidase A