Abstract
Purpose :
Birdshot chorioretinopathy (BCR) is an ophthalmic disease not commonly associated with other systemic findings. However, systemic steroids or immunomodulatory therapy (IMT) is often needed to treat acute or chronic BCR, and those have significant morbidity associated with treatment. We present six eyes with BCR undergoing monotherapy with intravitreal dexamethasone implantation 0.7mg (Ozurdex; Allergan, Inc.) to review the efficacy and limitations of this treatment modality.
Methods :
A retrospective chart review was performed on patients at our practice with BCR. Eyes receiving Ozurdex monotherapy for the treatment of BCR with a minimum follow-up period of 6 months were included. Eyes which were concurrently receiving systemic steroids or IMT were excluded. Six eyes (3 patients) were included. The main outcome measure was quiescence of disease activity as measured by fluorescein angiogram, optical coherence tomography, ophthalmic exam, and patient symptoms. Secondary outcomes were improvement of best corrected visual acuity. We collected: visual acuity, central macular thickness (CMT), presence of vitritis, presence of retinal vasculitis on fluorescein angiography, intraocular pressure (IOP), and presence of cataract at baseline, 1 month, 3 months, and 6 months after beginning treatment.
Results :
All eyes were injected at intervals of 3-6 months if there was clinical evidence of worsening vision, macular edema, vitritis, or retinal vasculitis. All eyes achieved quiescence of disease activity with Ozurdex. The mean LogMar visual acuity was 0.18 ± 0.15 at baseline, 0.16 ± 0.10 at 1 month, 0.16 ± 0.12 at 3 months, and 0.13 ± 0.11 at 6 months (all p > 0.05). There was a trend towards improved visual acuity but was not statistically significant. One eye presented with macular edema with a CMT of 409 microns at baseline which improved to 248 microns at 6 months. Two eyes had vitritis and four eyes had retinal vasculitis, all eyes improved with treatment. Four eyes developed elevated IOP after the first injection of Ozurdex, but was successfully managed with topical therapy alone. None of our patients developed cataracts as a consequence of therapy.
Conclusions :
Our findings suggest that repeated injections of Ozurdex as monotherapy may be a valuable option in the treatment of BCR and could be used to delay the initiation of IMT. Further studies are warranted to evaluate the utility of local monotherapy with Ozurdex.
This is a 2021 ARVO Annual Meeting abstract.