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Francesco Pichi, Careen Y Lowder, Janet L Davis, Heena Patel, Sara J. Haug, Emmett Cunningham, Sunil K Srivastava; WIDE-FIELD IMAGING OF BIRDSHOT CHORIORETINOPATHY. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6185.
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To study retinal lesions in patients with birdshot chorioretinopathy using wide-field imaging and correlate them to disease progression and management.
A multicentre retrospective study was carried out on 52 eyes of 26 patients with birdshot chorioretinopathy, that underwent wide-field imaging with the Optos scanning laser ophthalmoscope and fluorescein angiography, and with the Spectralis Non-Contact Ultra-Widefield Module. This was combined with a complete clinical exam and analysis of the macula with OCT, and wide-field fundus autofluorescence images were compared to visual fields where available. The primary outcome was detection of disease activity with and without wide-field imaging. The secondary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging.
In 33 cases (63.5%), wide-field images revealed more retinal or chorioretinal alterations or pathologies with a farther extended demarcation than 9-field composite color fundus and fluorescein imaging. Management was altered in 7 of 26 patients (26.9%) based on the use wide-field imaging and angiography (P < .001). Wide-field fluorescein angiography revealed vasculitis not clinically evident in 38 of 52 eyes (73.1%), of which 26 with large caliber venous staining and leakage (68.4%) and 12 (31.5%) with peripheral small venule staining and leakage, peripheral retinal atrophy in 9 eyes (17.3%), optic disk leakage in 16 eyes (30.8%), macular edema with leakage in 16 eyes (30.7%). Eight patients (16 eyes) underwent wide-field fundus autofluorescence, showing multiple hyperfluorescent spots in retinal periphery in 9 eyes (56.2%). The presence of macular hypoautofluorescence in 3 patients correlated with the duration of the disease, a decreased visual acuity and the degree of inflammation in the affected eye, indicating a secondary diffuse lesion in the pigment epithelium in relation to a thinning of the choroid. Findings from wide-field FAF imaging showed correspondence to visual field defects.
Wide-field imaging is a valuable tool in the management of patients with birdshot chorioretinopathy and can be used for the diagnosis, treatment, and follow-up and may alter management decisions compared to standard-of-care imaging and clinical examination.
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