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Astrid Queant, Dominique Monnet, Antoine Brezin; Fundus autofluorescence and birdshot chorioretinopathy: a study of 162 patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5376.
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© ARVO (1962-2015); The Authors (2016-present)
To report the characteristics of fundus autofluorescence in birdshot chorioretinopathy (BCR).
Our study was based on the prospective follow-up of an open cohort of patients with BCR examined yearly in a standardized manner since 2002 as previously reported (Monnet et al., Am J Ophthalmol. 2006; 141:135-42). Autofluorescence (AF) imaging was performed as an additional test for patients examined in 2011. All patients had simultaneous acquisition of OCT and posterior pole AF imaging with the Heidelberg Retina Angiograph (HRA Spectralis®). The characteristics of AF were analyzed in the peripapillary area and at the posterior pole.
310 eyes of 162 patients (66 men (40.7%), mean age 59.1 ± 10.8 years) were included in the analysis. In 48 eyes AF images could not be obtained or were of insufficient quality to be analyzed. The average logMAR best corrected visual acuity (BCVA) was +0.18 ± 0.4 and the average central macular thickness was 290.7 ± 90 μm. In 137 (44.2%) eyes AF quality image was imperfect, mostly because of shadows caused by opacities anterior to the retinal plane [95 eyes, (30.6%)]. Abnormalities of AF images were observed in 295 (95.2%) eyes and peripapillary atrophy was the most common finding, seen in 256 (82.6%) eyes. Other findings were a hyperautofluorescent line at the border of the optic disc in 79 (25.5%) eyes, extended macular hypoautofluorescence (73 eyes, 23.5%), heterogeneous macular AF (58 eyes, 18.7%), hypoautofluorescent spots (134 eyes, 43.2%) with a dominent perivascular location (108 eyes, 34.8%) and vascular unsharpened edges (81 eyes, 26.1%). Abnormal macular AF was correlated with increased macular thickness (p=0.013) as analyzed by OCT and with decreased visual acuity (p<0.01). Perivascular AF showed many atrophic retinal pigment epithelium (RPE) lesions, which were linked to a history of vasculitis. In 63 (20.3%) eyes posterior pole (PP) hypoautofluorescent spots did not coincide with the typical hypopigmented spots of BCR disease (seen in the PP in 94 (30.3%) eyes). Hypoautofluorescent spots were located in areas of RPE atrophy as seen by fluorescein angiography in 100 (32.3%) eyes.
The heterogeneity of the clinical presentation of BCR was reflected by a spectrum of images observed by AF. AF may provide additional information useful for the monitoring of patients and may help to better understand the mechanisms of tissue damage in the disease.
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