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T. Missotten, G. S. Baarsma, J. A. van Laar, T. van der Loos, P. L. van Daele, K. W. Geul, M. J. Eijkemans, P. M. van Hagen; Prognostic Factors Available at First Presentation in Birdshot Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6042.
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to identify prognostic factors available at presentation predicting long term outcome in Birdshot patients
46 patients currently followed for Birdshot retinopathy were included in the study. Studied outcome parameters were presence of longterm driving visual acuity and legal blindness, as these parameters are very relevant for patients. The studied prognostic factors available at onset were delay to presentation and systemic therapy, gender, age at presentation, presenting visual acuity and initial activity (IUSG grading). Logistic regression analysis was performed to identify significant risk factors.
In these 46 patients (24 female, 22 male), with a panuveitis consistent with the clinical entity of Birdshot retinopathy and in 95% of cases presence of the HLA A29 gene, significant (p<0.05) predicting factors by univariate and multivariate analysis were delay to presentation (less than 6 weeks) and in a lesser degree initial visual acuity. Age and gender were not significantly related to outcome.
The delay time to diagnosis (and start of systemic therapy) was the most significant predictive factor for long-term outcome, both for driving visual acuity and legal blindness. The study suggests any patient with panuveitis and multifocal choroiditis (or suspected birdshot retinopathy) should be referred to specialist uveitis centres without delay. These uveitis centres would be required to ensure referral times not to exceed 6 weeks, regardless of visual acuity of the referred patients, in order to be able to provide optimal care.
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