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SARA TOUHAMI, Christine Fardeau, Claude Simon, Juliette Knoeri, Bahram Bodaghi, Phuc Lehoang; 20-year experience of Birdshot Chorioretinopathy: Prognostic factors of long-term visual outcome.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2842.
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© ARVO (1962-2015); The Authors (2016-present)
To analyse the epidemiologic, clinical and paraclinical prognostic factors of Birdshot Chorioretinopathy (BCR).
Retrospective review of 56 successive BCR patients seen at a single tertiary referral center (Pitié Salpétrière Hospital, Paris) for a routine visit between May 2nd and August 16th, 2013. For each patient, visual status at latest visit was determined based on endpoint results for clinical examination, visual acuity (VA), optic coherence tomography (OCT), automated visual field (AVF), angiography and electrophysiology. Epidemiologic, clinical, OCT, AVF, angiographic and electrophysiologic data at initial assessment was collected and correlated to final visual status using chi2 and logistic regression models.
Cohort mean follow-up was 7 years (range 0.3-20.5). Mean age was 59 years (range 41-82); F/M-Sex-ratio was 1.6. Mean disease duration was 8 years (range: 1.2-20.5). Factors associated with a good visual prognosis were (respectively best vs worst outcomes): late age of disease onset (54 vs 46.4 years), absence of cardiovascular history (1.25% vs 12.5%), presence of vitreous inflammation (35.7% vs 6.25%), choroidal spots (71.5% vs 40%) or vascular leakage (35.7% vs 9.4%) at initial assessment; preserved maximal value at initial electro-oculographic evaluation (mean: 760 vs 580 mV), absence of retinal vasculitis at initial evaluation (25% vs 81%), presence of macular oedema at initial evaluation (33.25% vs 6.25%), initial 10-2 AVF MD>-10 (82.5% vs 50%), early initiation of immunosuppressive (IS) treatment (time interval between symptom onset and initiation: mean: 1600 vs 2500 days); all p<0.05 .
BRC is an insidious affection that can lead to blindness in a subclinical manner. Severity of initial inflammation alerts the clinician and leads to an aggressive combined corticosteroid (CT) and IS treatment, which seems to be correlated with a good prognosis. In the absence of such symptoms, natural history of BRC with either no treatment or CT therapy alone seems to be associated with a worsening of vision despite apparent clinical remission. This study suggests a pattern of prognostic factors that can help tailor the monitoring and treatment of BCR patients. Intensive and early initiation of IS treatment seems to be associated with the best prognoses.
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