Long-term clinical and anatomic outcome of birdshot chorioretinopathy.

Abstract

IMPORTANCE:

Birdshot chorioretinopathy is a chronic intraocular inflammatory disease with no uniform method to document long-term disease progression or response to treatment.

OBJECTIVE:

To examine the long-term visual, clinical, and anatomic outcomes of patients with birdshot chorioretinopathy.

DESIGN, SETTING, AND PARTICIPANTS:

A retrospective evaluation of 46 patients with birdshot chorioretinopathy treated at Moorfields Eye Hospital, London, England, was conducted. Medical records for a 19-year period (1993-2012) were reviewed.

EXPOSURES:

Patients received no treatment, short-term (≤1 year) treatment including local or systemic corticosteroids, or long-term (>1 year) treatment including systemic corticosteroids and second-line immunosuppressive agents.

MAIN OUTCOMES AND MEASURES:

Details regarding clinical and anatomic outcome, including best-corrected visual acuity, and visual field indices were evaluated.

RESULTS:

Ninety-two eyes of 46 patients were monitored for a mean (SE) of 57.2 (5.8) months (445 eye-years, 17% follow-up of ≥10 years). Patients maintained a steady best-corrected visual acuity throughout the follow-up period. Some clinical indices correlated with transient worse best-corrected visual acuity, including presence of cataract (P = .05), foveal leakage on fluorescein angiography (P = .04), and increased central retinal thickness (P = .02). Serial visual field studies demonstrated that patients who received only short-term treatment had a worsening of their pattern standard deviation with time (Spearman correlation, 0.57; P = .003); for those who received long-term treatment, the pattern standard deviation remained stable (Spearman correlation, -0.24; P = .26).

CONCLUSIONS AND RELEVANCE:

Our results suggest that central visual acuity can be maintained long term in patients with birdshot chorioretinopathy. Those who receive long-term immunosuppression appear to maintain better peripheral visual fields compared with patients who receive short-term treatment.

• Authors: Oren Tomkins-Netzer, Simon R J Taylor, Sue Lightman
• Journal: JAMA ophthalmology (JAMA Ophthalmol) Vol. 132 Issue 1 Pg. 57-62 (Jan 2014) ISSN: 2168-6173 [Electronic] United States
• PMID: 24336967 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• HLA-A Antigens
• HLA-A29 antigen
• Immunosuppressive Agents

Topics

• Birdshot Chorioretinopathy
• Chorioretinitis (diagnosis, drug therapy, physiopathology)
• Female
• Fluorescein Angiography
• Follow-Up Studies
• Glucocorticoids (therapeutic use)
• HLA-A Antigens (blood)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity (physiology)
• Visual Fields (physiology)