Retinal and pre-retinal nodules: A rare manifestation of probable ocular sarcoidosis

PURPOSE: To report a case of multiple pre-retinal and intra-retinal lesions in the context of probable sarcoidosis. OBSERVATIONS: A 31-year-old black woman presented with a bilateral panuveitis and multiple pre-retinal and retinal nodules. The workup showed enlarged mediastinal lymph nodes as well as meningitis with an increased cerebrospinal fluid angiotensin-converting enzyme (ACE) [0.36 UI/L (1.44 × normal)] leading to the diagnosis of probable sarcoidosis. The nodules were hyper-reflective, with posterior shadowing on OCT imaging, and appeared as multiple hypoautofluorescent spots: their characteristics were suggestive of intra and preretinal granulomas. The intraretinal nodules were located in the ganglion cell layer. The posterior segment manifestations were limited to the retina while the choroid appeared uninvolved including on indocyanine green angiograms. The lesions disappeared after corticosteroid treatment. CONCLUSIONS AND IMPORTANCE: Retinal and pre-retinal nodules have rarely been reported as the sole posterior manifestations of ocular sarcoidosis without choroidal involvement.