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Andrea Birnbaum, Amani Fawzi, Lana Rifkin, Debra Goldstein; Correlation between Disease Activity and Choroidal Patterns by OCT-EDI in Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5204.
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Birdshot chorioretinopathy (BCR) is characterized clinically by chorioretinal lesions, vasculitis, and macular edema. Visual acuity is often preserved, despite significant loss of functional vision. Patients are followed with clinical examination, OCT, fluorescein angiography (FA). Serial electroretinography and visual field testing are often performed to detect functional changes missed on other examination, although these tests can show fluctuations and are often cumbersome to perform. OCT enhanced depth imaging (EDI) allows visualization of structures posterior to the retinal pigment epithelium, and is easy to perform. The aim of this study is to correlate clinical signs of disease activity with choroidal patterns apparent on OCT-EDI.
Medical records of patients evaluated by a single investigator from July - December 2012 with a diagnosis of BCR were reviewed and disease activity was graded based on subjective complaints; clinical examination findings; FA including assessment for late leakage and cystoid macular edema (CME); and retinal OCT revealing CME. Only patients who were HLA-A29 positive were included in the study. Choroidal assessment was not included in these criteria. The OCT-EDI of each patient was then evaluated in a masked fashion based on the presence of following choroidal changes: visibility and ability to discern individual vascular structures (capillary, middle and deep vessels), interruptions of regular vascular pattern, intensity and size of inter-vascular stromal regions, presence of diffuse pockets of suprachoroidal hyporeflectivity.
13 patients were evaluated clinically and by OCT-EDI at several time points. Several clear clinical patterns of EDI changes were observed, and disease activity judged clinically could be correlated with EDI findings. As well, specific EDI findings including the vascular pattern and pockets of suprachoroidal hyporeflectivity correlated well with subjective complaints of photopsias.
Disease activity assessed clinically can be correlated with specific choroidal patterns on OCT-EDI. As well, subjective symptoms of photopsias, which do not always have easily recognized objective clinical, OCT or FA findings, were able to be clearly correlated with EDI features. OCT-EDI offers clinicians another tool to monitor disease activity and response to treatment in patients with BCR.
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