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Revised criteria of International Workshop on Ocular Sarcoidosis (IWOS) for the diagnosis of ocular sarcoidosis
  1. Manabu Mochizuki1,2,
  2. Justine R Smith3,
  3. Hiroshi Takase1,
  4. Toshikatsu Kaburaki4,
  5. Nisha R Acharya5,
  6. Narsing A Rao6
  7. for the International Workshop on Ocular Sarcoidosis Study Group
    1. 1 Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
    2. 2 Miyata Eye Hospital, Miyakonojo, Japan
    3. 3 Flinders University School of Medicine and Public Health, Adelaide, South Australia, Australia
    4. 4 Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
    5. 5 F. I. Proctor Foundation and Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
    6. 6 Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
    1. Correspondence to Professor Manabu Mochizuki, Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; m.manabu.oph{at}tmd.ac.jp

    Abstract

    Aims International criteria for the diagnosis of ocular sarcoidosis (OS) was established by the first International Workshop on Ocular Sarcoidosis (IWOS) and validations studies revealed certain limitations of the criteria. To overcome the limitations, revised IWOS criteria was established in an international meeting. This manuscript was aimed at reporting the revised IWOS criteria.

    Methods A consensus workshop was carried out to discuss and revise the IWOS criteria. The workshop was held on 27 April 2017, in Nusa Dua, Bali, Indonesia. Prior to the workshop, a questionnaire proposing revised criteria and consisting of one item for differential diagnosis, seven items for ocular clinical signs, 10 items for systemic investigations and three categories of diagnostic criteria was circulated to 30 uveitis specialists. Questionnaire items with over 75% support were taken as consensus agreement; items with below 50% support were taken as consensus disagreement and items with 50%–75% support were discussed at the workshop. Of the latter items, those supported by two-thirds majority in the workshop were taken as consensus agreement.

    Results The survey and subsequent workshop reached consensus agreements of the revised criteria for the diagnosis of OS as follows: (1) other causes of granulomatous uveitis must be ruled out; (2) seven intraocular clinical signs suggestive of OS; (3) eight results of systemic investigations in suspected OS and (4) three categories of diagnostic criteria depending on biopsy results and combination of intraocular signs and results of systemic investigations.

    Conclusions Revised IWOS criteria were proposed by a consensus workshop.

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    Footnotes

    • Collaborators Massimo Accorinti, Nisha R Acharya, Fatma Asyari, Kalpana Babu, Soumyava Basu, Jyotirmay Biswas, Bahram Bodaghi, Soon-Phaik Chee, Ramandeep Chhabra, Claude L. Cowan, Debra A Goldstein, Hiroshi Goto, Yih-Shiou Hwang, Mami Ishihara, Douglas A Jabs, Nicholas P Jones, Toshikatsu Kaburaki, Hidetoshi Kawashima, Moncef Khairallah, Phuc LeHoang, Kazuichi Maruyama, Peter McCluskey, Manabu Mochizuki, Philip I Murray, Kenichi, Namba, Nobuyuki Ohguro, Shigeaki Ohno, Annabelle A Okada, Narsing A Rao, Tsutomu Sakai, Shwu-Jiuan Sheu, Justine R Smith, Ko-hei Sonoda, Somsiri Sukavatcharin, Hiroshi Takase, Ilknur Tugal-Tutkun, Hyeong Gon Yu, Manfred Zierhut.

    • Contributors MM and JRS conceived the project; designed the study; collected the questionnaire survey; designed, conducted and moderated the sixth International Workshop on Ocular Sarcoidosis on 29 April 2017 in Nusa Dua, Bali, Indonesia, and drafted the manuscript. JRS, HT, TK, NRA and NAR reviewed and edited the manuscript draft. HT analysed the results of the questionnaire survey. MM, JRS, HT and TK built up questionnaire survey. NRA designed the study and reviewed the questionnaire survey. NAR made suggestions for the study. All authors and members of International Workshop on Ocular Sarcoidosis Study Group participated in the questionnaire survey and in the sixth International Workshop on Ocular Sarcoidosis on 29 April 2017 in Nusa Dua, Bali, Indonesia. All authors approved submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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