Purchase this article with an account.
L. Cimino, C.P. Herbort, C.P. Herbort; Posterior Sub-Tenon's Triamcinolone Injections for Birdshot Retinochoroidopathy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2409.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose. Birdshot retinochoroidopathy is a non infectious inflammatory entity limited to the eye. The degree of severity of the disease varies but in most cases the disease is slowly progressing and needs prolonged treatment. In this long term treatment strategy the best cost/benefit ratio has to be found and the treatment capital has to be managed. Periocular therapy might therefore be useful in this exclusively ocular disease, allowing to delay and/or shorten the use of systemic therapy. The aim of this study was to evaluate the efficacy of posterior sub-Tenon’s triamcinolone injections in birdshot retinochoroidopathy. Patients and Methods: Patients seen in the Uveitis Clinic at La Source Eye Centre, Lausanne, Switzerland and newly diagnosed with birdshot retinochoroidopathy were included in the study. In case of sufficient functional impairment to justify treatment, patients were treated with up to 3 posterior subTenon’s triamcinolone acetate injections (40 mgs) in a period of 3 months. The effect on visual acuity, visual field, fluorescein angiography (FA), indocyanine green angiography (ICGA) and laser flare photometry (LFP) was recorded. The time interval to renewed treatment was noted, at which time it was planed to initiate systemic therapy. Results: Six patients, all women, mean age 48.6±10.8, were included in this protocol. All patients were HLA-A29 positive and received a mean of 1.4±1.2 injections per eye. Visual acuity improved from 0.95±0.2 to 1.08±0.2 (p<0.04), visual field mean defect decreased from 8.05±6 to 2.53±3.9 (p<0.02) and laser flare photometry decreased from 12.6±6.8 to 6.2±2.1 ph/ms (p<0.02). Angiographic scores decreased for FA from 2.95±1.2 to 0.8±0.4 (P<0.0001) and for ICGA from 3.1±1.2 to 0.85±0.4 (p<0.0001). Systemic therapy had to be initiated in 4/6 patients at a time interval of 14.5±4.1 months and i2 patients were treatment free after a mean follow-up of 35 months. Conclusions: Posterior subTenon’s steroid injections were extremely effective on all functional and inflammatory parameters and allowed to avoid systemic therapy in 2 patients and to delay it for more than one year in the 4 patients that had to go on to systemic therapy. Taking into account this excellent effect and the purely ocular location of inflammation it is probably of interest to treat this predominantly feminine patient population locally as long as possible.
This PDF is available to Subscribers Only