Elsevier

Ophthalmology

Volume 105, Issue 8, 1 August 1998, Pages 1393-1397
Ophthalmology

Arterial macroaneurysms in peripheral multifocal chorioretinitis associated with sarcoidosis

https://doi.org/10.1016/S0161-6420(98)98018-6Get rights and content

Abstract

Objective

This study aimed to describe the clinical presentation, angiographic findings, and natural history of acquired arterial macroaneurysms diagnosed in 8 of 48 patients with peripheral multifocal chorioretinitis (PMC) (panuveitis with multiple peripheral punched-out chorioretinal lesions).

Design

A retrospective case-control study.

Participants

Forty-eight consecutive patients with PMC, consisting of 13 patients with histologically or radiologically proven sarcoidosis, 11 with laboratory evidence of (presumed) sarcoidosis, and 24 with no evidence of systemic disease, participated in the study.

Intervention

A review of the clinical, photographic, and angiographic records was performed.

Main outcome measures

Arterial macroaneurysms, clinical symptoms, and associations with systemic disease were measured.

Results

Of 48 patients with PMC, 8 (17%) had arterial macroaneurysms: 3 (38%) of 8 with histologically proven sarcoidosis, 1 (20%) of 5 with radiologically proven sarcoidosis, 2 (18%) of 11 with laboratory evidence of sarcoidosis, and 2 (8%) of 24 patients with no evidence of systemic sarcoidosis. All eight patients were white females older than 60 years of age. Macroaneurysms appeared to be unrelated to the systemic hypertension (5 of 17 compared to 3 of 31; P = 0.11); however, the frequency of cerebrovascular accidents or myocardial infarctions was higher among those with macroaneurysms (5 of 8 vs. 2 of 40; P = 0.0000). Three of the eight patients reported visual complaints related to macroaneurysms; only one patient required laser treatment. Fluorescein angiography showed no evidence of previous vasculitis in the involved area.

Conclusions

Arterial macroaneurysms, which occur in elderly female patients with PMC, are associated with severe cardiovascular disease. Whether the macroaneurysms are a complication of an inflammatory vascular process remains speculative.

Section snippets

Patients and methods

We reviewed the clinical and photographic records of 48 consecutive patients with PMC of the F.C. Donders Institute, University Hospital Utrecht, to assess the frequency and clinical features of an arterial macroaneurysm and to determine eventual risk factors contributing to its development.

All patients had chronic vitreitis with more than ten peripheral chorioretinal punched-out lesions. None of the patients had inflammatory chorioretinal lesions located within the large vascular arcades,

Results

The study included 8 male and 40 female patients with PMC. The average follow-up for PMC was 4.2 years; follow-up of the eight patients after the diagnosis of the macroaneurysm was at least 1 year (average, 2 years). The mean age at onset of PMC was 59 years.

Of 48 patients with PMC, 8 had arterial macroaneurysms (17%): 3 of 8 (38%) with histologic and 1 of 5 (20%) with radiologic confirmation of sarcoidosis, 2 of 11 (18%) with high angiotensin-converting enzyme levels and 2 of 24 (8%) who

Case 1

A 63-year-old woman with peripheral multifocal chorioretinitis and biopsy-proven sarcoidosis diagnosed at the age of 61 developed an arterial macroaneurysm of the inferior temporal artery in her best eye (Fig 1). Her ophthalmologic history included asymmetric sarcoid uveitis since the age of 61; she had mild chronic vitreitis in her right eye with peripheral punched-out lesions and a visual acuity of 20/20. However, she had severe panuveitis in her left eye with a peripheral choroidal granuloma

Discussion

In this study, arterial macroaneurysms were found in 8 (17%) of 48 patients with vitreitis and multiple punched-out lesions located in the periphery of the retina; 4 of these 8 had either histologically or radiologically proven sarcoidosis. In literature surveys, however, no other association of arterial macroaneurysm than that with cardiovascular diseases has been reported.2, 3, 4, 5, 6, 7, 8 The exact frequency of macroaneurysms in association with hypertension or other types of

References (19)

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