Abstract
Abstract: :
Purpose: To report the clinical outcomes of patients with birdshot retinochoroidopathy (BSRC) treated with systemic immunomodulatory therapy (IMT) during a follow–up of one year or longer. Methods:Charts of patients with ocular inflammatory diseases treated by the Immunology and Uveitis Service at the Massachusetts Eye and Ear Infirmary (MEEI) were reviewed. Data on age, sex, presence of HLA–A29 haplotype, follow–up time, time delay to diagnosis, previous treatment, type of IMT during follow–up, initial and final Snellen visual acuities (VA), initial and final eletroretinograms (ERGs), and ocular and extraocular complications were recorded. Results:Twenty–four patients (48 eyes) were included in the study. The mean age at diagnosis was 50 years. Fifty–four percent of patients were female, 46% were male. Ninety–six percent of patients were HLA–A29 positive. The mean follow–up period was 80 months. Time delay to diagnosis or referral to MEEI was 20 months. Forty–six percent of patients received no treatment prior to referral. The most common treatment prior to referral was oral steroids or steroid drops (63%). None of the patients had sufficient control of their symptoms prior to referral. During follow–up, 92% of patients were treated with cyclosporin (mean duration of 53 months), 67% with mycophenolate mofetil (mean duration of 22 months), 17% with azathioprine (mean duration of 81 months), 8% with daclizumab (mean duration of 12 months). Six patients received one injection each of intravitreal triamcinolone. One patient was treated with oral methotrexate for 36 months. The most common side–effect of treatment was reversible worsening of renal function sufficient to alter the treatment regimen (17%). Ocular complications of BSRC or steroids were cataract (50%), cystoid macular edema (33%), glaucoma (21%), epiretinal membrane (13%), and retinal detachment (4%). The average VA at the time of initial visit was 0.65. The average final VA was 0.82. The 30 Hz flicker implicit time was prolonged in 68%, and normal in 32% of patients in both the initial and final ERGs. The bright scoptic amplitude was abnormal in 41% of initial ERGs and in 35% of final ERGs. Conclusion:Long–term preservation of visual function, as measured by Snellen chart and ERG, is achievable with systemic corticosteriod–sparing IMT in patients with BSRC.
Keywords: chorioretinitis • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials