June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Development of Choroidal Depigmentation in Birdshot Retinochoroidopathy Patients Treated with Fluocinolone Acetonide Implants
Author Affiliations & Notes
  • Blake Isernhagen
    Ophthalmology, Bascom Palmer Eye Institute, Miami Beach, FL
  • Heena Patel
    Ophthalmology, Bascom Palmer Eye Institute, Miami Beach, FL
    Retina Institute, Los Angeles, CA
  • Sara Haug
    West Coast Retina, San Francisco, CA
  • Emmett Cunningham
    California Pacific Medical Center, San Francisco, CA
  • Francesco Pichi
    San Giuseppe Hospital, University Eye Clinic, Milan, Italy
  • Careen Y Lowder
    Cleveland Clinic, Cleveland, OH
  • Sunil K Srivastava
    Cleveland Clinic, Cleveland, OH
  • Janet L Davis
    Ophthalmology, Bascom Palmer Eye Institute, Miami Beach, FL
  • Footnotes
    Commercial Relationships Blake Isernhagen, None; Heena Patel, None; Sara Haug, None; Emmett Cunningham, None; Francesco Pichi, None; Careen Lowder, Xoma (C); Sunil Srivastava, None; Janet Davis, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 1720. doi:
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      Blake Isernhagen, Heena Patel, Sara Haug, Emmett Cunningham, Francesco Pichi, Careen Y Lowder, Sunil K Srivastava, Janet L Davis; Development of Choroidal Depigmentation in Birdshot Retinochoroidopathy Patients Treated with Fluocinolone Acetonide Implants. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1720.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To report progressive posterior choroidal depigmentation during long-term follow-up in patients with birdshot chorioretinopathy (BCR) undergoing implantation with a fluocinolone acetonide containing device despite otherwise excellent control of inflammation.

 
Methods
 

Retrospective comparative case series of BCR patients from one university and two private uveitis clinics. Evaluation of baseline vs. follow-up fundus color photographs after a minimum of 30 months were compared in patients treated with the fluocinolone implant or systemic immunosuppression. Available fluorescein angiography, indocyanine green, autofluorescence, and optical coherence tomography were also compared. The primary outcome measure was an “unequivocal” change in background choroidal depigmentation on color fundus photography graded by two masked observers, compared by chi-square. Mean group follow-up time was compared by t-test.

 
Results
 

Group 1 included 10 patients (20 eyes) treated with fluocinolone implants and Group 2 included 10 patients (20 eyes) treated with immunosuppression during the study period. Both groups had similar demographics for age, sex, and initial and follow-up visual acuity. Follow-up for Group 1 was median 75 months and mean 69 months. Group 2 was median 57 months and mean 64 months (P=0.29 by t-test). Ocular inflammation in both groups improved based on clinical information and imaging studies. Evaluable photographs demonstrated depigmentation in 10 eyes of 6 patients in Group 1 and 4 eyes of 4 patients in Group 2 (chi-square 3.96, P< 0.05).

 
Conclusions
 

Patients treated with the fluocinolone implant had a higher frequency of choroidal depigmentation unassociated with RPE atrophy despite good clinical control of inflammation and preserved vision. The results may indicate a specific effect of corticosteroids on choroidal pigment or a differential effect of intravitreal vs. systemic treatment in BCR, a panuveitis that involves vitreous, retina, RPE, and choroid. Additional follow-up and standardized photographs are needed to confirm this finding and determine if similar changes occur in other types of uveitis.  

 
Fluocinolone patient: initial photo on left and follow-up photo on right demonstrating progressive choroidal depigmentation.<br />
 
Fluocinolone patient: initial photo on left and follow-up photo on right demonstrating progressive choroidal depigmentation.<br />
 
 
Patient treated with immunosupression: initial photo on left and follow-up photo on right demonstrating stable choroidal pigmentation.
 
Patient treated with immunosupression: initial photo on left and follow-up photo on right demonstrating stable choroidal pigmentation.

 
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