Abstract
Purpose :
Birdshot chorioretinitis (BSCR) is a chronic uveitis that can lead to a progressive loss of visual acuity and field over time. The aim of this study was to assess the manifestations of the disease in patients >80 years old.
Methods :
Among the patients with BSCR prospectively followed in our cohort (ClinicalTrials.gov Identifier: NCT05153057), we focused our analyses on those examined at age >80 years. Patients were assessed in a standardized manner including visual symptoms, best-corrected visual acuity (BCVA), dilated ophthalmic examination, visual field testing (Humphrey 30-2), fundus autofluorescence (FAF), fluorescein angiography and SD-OCT. When multiple visits occurred after age 80, data from the most recent visit were used. Active inflammation was defined by the presence of macular edema and/or vitritis and/or vasculitis and/or papillitis. Confluent atrophy was defined as hypoautofluorescent spots on FAF.
Results :
As of October 2021, 37 of 442 patients (8.8%, 74 affected eyes) were >80 years old at the most recent clinical visit. Mean age was 84.0 ± 3.7 years (range 80-93 years) and 24 (64.9%) patients were female. The mean disease duration was 22.4 years. Mean LogMAR BCVA was 0.53 ± 0.77 (range 0 – 2.3) in affected eyes, with 32 patients (86.5%) having 20/40 or better vision in at least one eye. Thirty-two patients (86.5%) received treatment during follow up. Systemic corticosteroids, immunosuppressants, and corticosteroid injections [intravitreal or sub-tenon] were previously prescribed in 24 (64.9%), 16 (43.2%) and 21 (56.8%) patients respectively. Thirty-three patients (89.2%) were receiving no treatment and 57 eyes (81.4%) in 30 patients (85.7%) had no active inflammation at the most recent visit. Confluent atrophy in the posterior pole was observed in 30 (42.8%) eyes in 17 patients (48.6%). Patients with confluent atrophy had significantly worse mean BCVA (LogMAR 1.0±0.94 vs 0.13±0.15, p<0.0001), longer mean disease duration (26.9±9.8 vs 17.6±9.0 years, p=0.0005), thinner mean central macular thickness on SD-OCT (245.6±117.2 vs 268.0±48.8 µm, p=0.002) and worse visual field mean deviation (-15.1±7.7 vs -6.8±6.0 dB, p=0.0003).
Conclusions :
The majority of patients with BSCR aged >80 have preserved BCVA of 20/40 or better in at least one eye over several decades of disease duration. Confluent atrophy in the posterior pole was correlated with worse visual function in these patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.