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Marina Papadia, Carlo E. Traverso, Carl P. Herbort; Birdshot Chorioretinitis, Choroidal versus Retinal Involvement : The Global Picture. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2749.
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Aim of this study was to evaluate the respective inflammatory involvement of the retina (fluorescein angiography - FA) and the choroid (Indocyanine green angiography - ICGA) in a longitudinal study of patients with birdshot chorioretinopathy (BC).
BC patients that were investigated in Centre for Ophthalmic Specialised Care, Lausanne, Switzerland between 1995 and 2009 were analysed retrospectively.18 patients with BC were included in the study. Patients underwent a classical uveitis work-up with fluorescein angiography (FA), Indocyanine green angiography (ICGA), visual field (VF) testing and laser flare photometry at presentation and during follow-up and optical coherence tomography (OCT) was performed. FA and ICGA were scored according to a previously published scale.
All patients were HLA-A29 positive. Mean age at presentation was 49.6±10.0 years, mean diagnostic delay was 21.6±18 months and mean follow-up was 85.6±60.8 months. diagnostic delay was 21.6±18 months and mean follow-up was 85.6±60.8 months. 3/18 patients presented with mutton-fat keratic precipitates (KPs), 4/18 had no depigmented lesions at presentation and 8/18 did not fulfil the criterion of 3 depigmented peripapillar lesions put forward by the IRDC. Cystoid macular oedema (CMO) at entry was present in 8/18 cases. VF defects, were noted in all patients at presentation. FA scores were 9.5 ±2.7 at the first visit and 8.6±3.2 at last follow-up. ICGA were 8.2±3.9 at first visit and 4.3±3.6 at last follow-up (p<0.001). Additional findings contradicting present notions on BC were presence of granulomatous KPs, occult early involvement of choroid and importance of visual field testing at presentation and follow-up.
BC is a granulomatous uveitis and FA and ICGA scores show differential inflammatory patterns of retina and choroid as well as differential response to therapy. Our study shows the importance of following inflammatory involvement in both compartments with appropriate methods if precise evaluation of disease is aimed at.
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