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Kenneth Warren Price, Samera Ahmad, Steven Yeh, Jessica Gowramma Shantha; The Use of Adjuvant Local Therapy in a Cohort of Patients with Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5351.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the use of adjuvant local therapy in conjunction with systemic treatment in a cohort of Birdshot Chorioretinopathy (BCR) patients.
Retrospective chart review of 63 individuals who were diagnosed with BCR and underwent treatment at Emory University Eye Center between 2006 and 2018.
126 eyes of 63 patients were monitored for a mean follow-up time of 52.8 months (range 2 -176). Average age at presentation was 57.1 years old (range 35.4 – 90.5). Of the 63 individuals, 41 (65%) required systemic immunosuppression which included 32 (51%) on systemic glucocorticoids, 29 (46%) on systemic antimetabolites, 12 (19%) on systemic TNF-alpha inhibitors, or 5 (8%) on other systemic immunosuppression. An average of 1.5 systemic medications was utilized across all patients. 39 (62%) of the 63 required any local therapy during their treatment including topical Prednisolone Acetate [16 (25%)], topical Difluprednate [13 (21%)], topical Nepafenac [6 (10%)] or injectable steroids including retroseptal/subtenon triamcinolone (17 (27%)], intravitreal Dexamethasone implant [5 (8%)], Fluocinolone intravitreal implant [6 (10%)], or intravitreal triamcinolone [1 (2%)]. An average of 1.2 local medications was used in all patients. 3 patients (5%) chose local therapy over systemic due to risks of immunosuppression. Of the 41 patients already on systemic immunosuppression, local therapy was used in 11 (27%) for inadequate control of inflammation including persistent AC cell/flare [2 (5%)], CME [6 (15%)], and vasculitis [3 (7%)]. Complications of local therapy included elevation in intraocular pressure uncontrolled with topical antihypertensives requiring intervention [6 (15%)], migration of Fluocinolone implants [2 (5%)], and CSCR [2 (5%)].
There is a wide phenotype in terms of ocular inflammatory manifestations in Birdshot Chorioretinopathy. While systemic immunosuppression is mainstay in retaining long term vision, there were many individuals in our cohort who did not have adequate control of inflammation and required local adjuvant therapy.
This is a 2020 ARVO Annual Meeting abstract.
Two patients with BCR and inadequately controlled inflammation. Figure 1A: recurrent Cystoid Macular Edema in a patient despite systemic Methotrexate, Figure 1B status post Ozurdex with CME resolution. Figure 2A: an individual with vasculitis in the left eye only despite systemic Mycophenolic acid, showing improvement in 2B after local Ozurdex.
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