Real-Life Evaluation of the Revised IWOS, Modified Abad and SUN Criteria in a Multicenter Cohort of 409 Patients with Sarcoid Uveitis.

PURPOSE: To evaluate and compare the International Workshop on Ocular Sarcoidosis (IWOS) revised diagnostic criteria, the modified Abad diagnostic criteria, and the Standardization of Uveitis Nomenclature (SUN) classification criteria in patients with sarcoid uveitis in a real-life setting.

METHODS: This multicenter cohort study included 409 patients with sarcoid uveitis managed at the Hospices Civils de Lyon between 2003 and 2024. All patients fulfilled the revised IWOS, modified Abad, and/or SUN criteria. Systemic and ophthalmologic data were retrospectively collected, and diagnostic confidence levels (definite, presumed, or probable sarcoid uveitis) were assigned for each scoring system.

RESULTS: Uveitis was often bilateral (79.1%) and granulomatous (73.7%). Panuveitis accounted for 43.3% of cases and anterior uveitis for 23.7% of cases. Bilateral hilar lymphadenopathy (BHL) was frequently observed on chest computed tomography (63.7%), along with elevated serum ACE levels (59.3%), and 18F-FDG PET was suggestive of sarcoidosis in 89.7% of 261 patients. Sarcoid uveitis was histologically confirmed in 71.5% of patients. The modified Abad criteria had the highest sensitivity (99.3%), followed by the IWOS (90.1%), and SUN criteria (83.4%). Exclusion from IWOS criteria was due to insufficient ophthalmologic signs (65.0%) or BHL absence (70.0%). Exclusion from SUN criteria was due to BHL absence (91.0%) or positive tuberculosis screening (29.8%).

CONCLUSIONS: The modified Abad criteria were the most sensitive for diagnosing sarcoid uveitis. The IWOS criteria sensitivity was lower due to stricter ophthalmologic and radiologic requirements. The SUN criteria sensitivity was lower due to stricter radiologic criteria and exclusion of patients with a positive tuberculosis screening.