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Jessica Shantha, Vincent Ho, Purnima Patel, Farzin Forooghian, Steven Yeh; Choroidal Neovascularization Associated with Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3854.
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Birdshot chorioretinopathy (BCR) is a rare cause of bilateral posterior uveitis associated with HLA-A29-positivity and represents less than 10% of posterior uveitis cases referred to tertiary care centers. Complications leading to loss of visual acuity (VA) include macular edema, optic disk edema, epiretinal membrane, and choroidal neovascular membrane (CNV) formation. Since its first description in 1983, the association of CNV with BCR has rarely been reported in the literature. The purpose of this study was to review our experience in the management of CNV associated with BCR.
A retrospective case review of 37 BCR patients from the Emory Eye Center and St. Paul’s Hospital (Vancouver, BC) was performed. Patients with clinical and fluorescein angiographic evidence of CNV were reviewed. Descriptive data collected included demographic data, ophthalmic exam findings, and immunosuppressive therapy. Main outcomes measured included initial and final visual acuity, mechanism of treatment, number of anti-VEGF injections, and spectral domain optical coherence tomography (SD-OCT).
Four of 37 BCR patients (10.8%) were identified to have CNV. Two were female and two were male, and one patient had bilateral CNV. The average age was 57 years at the time of CNV diagnosis. The mean follow-up was 18.5 months (Range 2-36 months). Mean logMAR VA improved from 0.41 (Snellen VA 20/50) to 0.26 (Snellen 20/30-20/40, p=0.09). All eyes maintained or improved vision during follow-up. Three of four BCR patients had macular lesions at the time of CNV diagnosis. Three patients were treated with systemic immunosuppression including mycophenolate mofetil (2), cyclosporine (1), and tacrolimus (1) and one patient received a fluocoinolone acetonide implant. Identification of CNV in all patients prompted anti-VEGF medications including bevacizumab (3) or ranibizumab (1). Affected eyes received a mean of 2.8 injections (Range 2-5). SD-OCT findings at the time of diagnosis included pigment epithelium detachment, photoreceptor disruption, cystoid macular edema, and subretinal fluid. Mean central subfield thickness improved from 352 microns to 228 microns (p=0.17) at final follow-up.
CNV, a rare complication of BCR, may be treated successfully with anti-VEGF medications. A combination of systemic or local immunosuppression and anti-VEGF therapy may be implemented for the management of CNV associated with BCR.
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