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Allison Ramsey Soneru, Marion Ronit Munk, Phoebe Lin, Amani A Fawzi, Debra A Goldstein; Multimodal Imaging of lesions in Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5311.
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© ARVO (1962-2015); The Authors (2016-present)
To describe two different types of chorioretinal lesions in birdshot chorioretinopathy using multimodal imaging techniques
Data was collected retrospectively on 34 eyes of 17 patients (15 women and 2 men) seen from 2008 to 2013 diagnosed with Birdshot Chorioretinopathy (BSCR). Their lesions were imaged using fundus photos, blue fundus autofluorescence (FAF) (488nm), near infra-red (NIR)-FAF (788nm), Infrared, Red-free, Spectralis SD-OCT and EDI-OCT.
The patients’ ages ranged from 44 to 68 years (mean age 57.8). They were imaged over a period of time ranging between a single visit and 5.5 years. All 17 of these patients presented clinically with deep choroidal lesions, whereas a subset of five of these patients (29%) also exhibited superficial, punched-out lesions compromising the integrity of the outer retina and the retinal pigment epithelium (RPE). These lesions were hypoautofluorescent in FAF and NIR-FAF and hyperreflective in infrared and red-free. On SD-OCT the superficial lesions demonstrated RPE-atrophy and disruption of the ellipsoid band and the interdigitation zone with focal enhancement of the choroidal signaling. The typical deep choroidal lesions, however, were not readily visible on any imaging techniques except fundus photography, unless the overlying RPE atrophied. However, some of the lesion corresponded to hyperreflective changes in the Sattler’s layer and the choriocapillaris in EDI-OCT. Once there was associated RPE-atrophy however, the deeper lesions were hypoautofluorescent, the Red free showed corresponding subtle hyperreflectivity and the SD-OCT revealed RPE atrophy and enhanced choroidal reflectivity due to increased signal penetration.
Patients with BSCR may present with two different lesion types (choroidal vs. outer retinal), a distinction never before made in the literature. The two distinct lesions are best imaged by a multimodal imaging approach. However, the clinicopathological and prognostic correlates of the two lesions needs to be further evaluated.
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