title: Diagnostic management of patients with suspected ocular sarcoidosis.
abstract: BACKGROUND
  Ophthalmologists often refer patients with suspected ocular sarcoidosis to pulmonologists for diagnostic examination of sarcoidosis. However, no recommendation has been proposed for managing such patients. This study aims to prospectively evaluate the diagnostic values of examinations and propose the management of patients with suspected ocular sarcoidosis.
  
  
  METHODS
  Consecutive patients with suspected ocular sarcoidosis were prospectively investigated according to type of ocular lesions, measurement of serum ACE, and findings of chest radiography, chest CT, bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Diagnostic values were calculated on the basis of pathological results.
  
  
  RESULTS
  Forty-two patients were included (female, 71.4%; mean age, 56.2±14.8 years), of whom 64.3% was diagnosed with sarcoidosis. Patient characteristics and ocular lesions did not differ significantly, regardless of the presence of sarcoidosis. Chest CT had low specificity and very high sensitivity for detecting sarcoidosis; in contrast, chest radiography and direct findings of bronchofiberscopy had high specificity and low sensitivity. Serum ACE and BAL did not have high diagnostic value. A flow chart was proposed to diagnose sarcoidosis, and this chart reduced the requirement of TBLB to 50% in our population. During the median follow-up of 51 months, 7 patients in the sarcoidosis group (25.9%) developed new lesions.
  
  
  CONCLUSIONS
  Application of our flow chart appears to detect avoidable TBLB. Development of a more comprehensive flow chart including survey of ocular findings is warranted.
authors.affiliation: Division of Respiratory and Allergy Medicine, Komaki City Hospital, 1-20 Johbuji, Komaki 485-8520, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Takada
authors.forename: Shuuichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Kojima
authors.forename: Susumu
authors.initials: S
authors.lastname: Iwata
authors.forename: Kentarou
authors.initials: K
authors.lastname: Tanaka
keywords: Sarcoidosis; diagnosis; examination; ocular sarcoidosis