Purpose: To represent and evaluate the findings of bilateral perifoveal macular ischemia in a patient with biopsy-proven, multiorgan involved sarcoidosis.
Methods: Case report. A 55-year-old man, with a medical history of pulmonary disease, experienced reduced vision bilaterally. General ocular examination, fundus color photographs, fluorescence angiography, and high-resolution spectral domain optical coherence tomography were performed in both eyes.
Results: The patient's visual acuity was 20/200 in the right eye and 20/30 in the left eye with normal intraocular pressure and anterior segment. Fundus examination showed symmetric changes with the loss of transparency in macular and small intraretinal hemorrhages in both eyes. Fluorescence angiography demonstrated markedly enlarged avascular zone while optical coherence tomography revealed marked cystic change in the macula bilaterally. A series of blood test was conducted without a specific diagnosis. A lung biopsy confirmed the diagnosis of pulmonary sarcoidosis, and a magnetic resonance imaging of his brain revealed neurosarcoidosis.
Conclusion: Bilateral perifoveal ischemia, formerly one of the three idiopathic macular telangiectasia diseases, is rare and usually suggests a systemic etiology. It is not unexpected that sarcoidosis, a multisystem, chronic inflammatory disorder, may affect retinal vessels and be associated with this peculiar form of ischemia and edema.