Birdshot Retinochoroidopathy (Grand Rounds)
- 1 Financial Disclosure
- 2 Chief Complaint
- 3 History
- 4 Examination
- 5 Differential Diagnosis
- 6 Final Diagnosis
- 7 Complications
- 8 Management
- 9 Additional Resources
- 10 Discussion
Saradha Iragavarapu, MD PGY-3
UNIVERSITY OF SOUTH FLORIDA
- Dr. Iragavarapu states that she has no financial interest, affiliation, or other relationship with the manufacture of any commercial project discussed or with the manufacture of any competing commercial project.
- "Foggy vision, difficulty with depth perception"
- 72 y/o WF referred by outside ophthalmologist for "retinal dystrophy"
- Sx began 10 years ago with blurred vision > difficulty with depth perception > dec color vision
- Diagnosed with "retinal problem' in 2005 and had 3 steroid injections
- "retinal problem"
- Grandmother- "legally blind"
- Aunt- "corneal problem"
- "water pill"
- Ex smoker, social drinker
- Born and raised in Tampa, FL
- No travel outside US
- No pets
- No recent URI's or illness
- Birdshot retinochoroidopathy (Diagnosis)
- Intraocular lymphoma
- Syphilitic chorioretinitis
- Sympathetic ophthalmia
- Vitiliginous chorioretinitis
- Salmon Patch Choroidopathy
- HLA A29-type 2
- 4th-6th decade of life
- Females affected slightly more than males
- floaters, blurred vision, peripheral photopsias, nyctalopia, and loss of color vision
- Creamy yellow-white lesions at level of rpe/choroid
- 500-1500um in size
- Typically extend radially from nerve to cover most of the nasal retina.
- 100% of patients with active disease have vitritis.
- Variable degree of disc edema, CME, retinal vasculitis
- Late stage optic atrophy
- Labs: ACE, lysozyme, PPD, CXR, FTA, HLA panel
- ERG findings
- Diminished 'b' wave in comparison to 'a' wave.
- Delayed 30Hz flicker time.
- FA findings
- "quenching" phenomenon where dye leaves retinal circulation quickly.
- Block early stain late
- Vasculitis/vascular leakage
- Inodcyanine Green findings
- Hypofluorescent lesions
- Decreased reflectivity of photoreceptor layer
- Round, hypofluorescent lesions
- Lymphocytic infiltrate in the choroid, optic nerve head, retinal vessels
- Optic atrophy
- Macular CNV (very rare)
- 20% of patients achieve remission without treatment.
- Cyclosporine 2.5-5mg/kg/day
- Azathioprine 1.5-2mg/kg/day
- Methotrexate 7.5-25mg/week
- Mycophenolate mofetil
- Daclizumab (not used anymore)
- G E Holder, A G Robson, C Pavesio, E M Graham. Electrophysiological characterisation and monitoring in the management of birdshot chorioretinopathy Br J Ophthalmol. 2005 June; 89(6):709-718.
- Ryan B, Rush, Debra A. Goldstein, David G. Callanan, Beeran Meghpara, William J. Feuer, Janet L. Davis. Outcomes of Birdshot Chorioretinopathy Treated With an Intravitreal Sustained-Release Fluocinolone Acetonide—Containing Device American Journal of Ophthalmology, Volume 151, Issue 4, Pages 630-636.
- Giuliari G, Hinkle DM, Foster CS. The spectrum of fundus autofluorescence findings birdshot chorioretinopathy Journal of Ophthalmology Epub, Volume 2008, 5 pages. Feb 8 2010.
- Rothova, Aniki MD, PhD, Ossewaarde-van Norel, Annette MD, Los, Leonoor I MD, PhD, Berendschot, Tos T J M PhD. Efficacy of low-dose Methotrexate in the treatment of Birdshot Chorioretinopathy. Retina. 31(6):1150-1155, June 2011.
- Birdshot retinochoroidopathy. Basic and Clinical Science Course. 2011.
- Kayur H. Shah, MD, Ralph D. Levinson, et al. Birdshot Chorioretinopathy A Major Review. Surv Ophthalmol. 2006 Jul-Aug;51(4):446-7
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