Impact of Treatment on Inflammatory Choroidal Neovascularization in Patients with Sarcoidosis

Purpose To demonstrate the influence of treatment with immunomodulatory therapy (IMT) on clinical and imaging findings in patients with sarcoidosis-associated choroidal neovascularization (CNV).Methods A retrospective chart review of patients diagnosed with sarcoidosis-associated CNV was performed. Clinical features, including number of intravitreal injections, best corrected visual acuity (BCVA), intraocular pressure (IOP), were collected prior to, during, and following IMT optimization. Multimodal imaging was qualitatively reviewed at baseline, post-injection therapy, and 1-year post IMT therapy. Metrics automatically generated by the Zeiss FORUM software platform were acquired for comparison across treatment timepoints.Results Sixteen eyes (10 patients) were analyzed. There was a median follow-up time of 34.5 months from diagnosis. Patients experienced a decrease trend in mean intravitreal injections per 12 months between baseline (1.17), active IMT (0.82), and optimized IMT (0.26). Median BCVA trended towards improvement from 20/50 to 20/35 (p = 0.9387) from baseline to 12 months of IMT. There was a decreasing trend in median values of central subfield thickness across (270 vs 268.5 vs 263.5; p = 0.8802), macular cube volume (10.65 vs 10.4 vs 10.25; p = 0.492), and average macular cube thickness (296.5 vs 290 vs 284; p = 0.4483) across sequential timepoints.Conclusions Despite variability in the time to presentation, patients experienced trends toward qualitative and quantitative recovery on clinical and imaging metrics when starting on IMT. This improvement led to fewer intravitreal injections, reducing associated procedural risk and improving outcomes. Unusual CNV should be investigated to rule out an underlying inflammatory cause.