Long-term clinical and anatomic outcome of birdshot chorioretinopathy

JAMA Ophthalmol. 2014 Jan;132(1):57-62. doi: 10.1001/jamaophthalmol.2013.6235.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Birdshot Chorioretinopathy
  • Chorioretinitis / diagnosis
  • Chorioretinitis / drug therapy*
  • Chorioretinitis / 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*

Substances

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