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Carl P Herbort - One of the best experts on this subject based on the ideXlab platform.
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Differential inflammatory involvement in retina and choroid in Birdshot Chorioretinopathy
Klinische Monatsblatter fur Augenheilkunde, 2004Co-Authors: Carl P Herbort, K Probst, L. Cimino, V. T. TranAbstract:BACKGROUND Birdshot Chorioretinopathy is characterised by dual unrelated inflammatory involvement of the retina and the choroid. Indocyanine green angiography made it possible to assess and follow choroidal disease with the same precision as retinal involvement was followed so far. The aim of this study was to analyse the severity, progression and response to therapy of both retinal involvement using fluorescein angiography and choroidal involvement using indocyanine green angiography. PATIENTS AND METHODS Patients with Birdshot retinochoroidopathy followed at La Source Eye Centre in Lausanne, Switzerland from January 1995 to December 2002 were subdivided into three subgroups according to the duration of evolution of the disease: untreated patients with no more than one year duration of the disease (group 1, n = 6); treated patients with disease duration of 1 - 7 years duration (group 2, n = 5) and patients with disease lasting for more than 7 years (group 3, n = 4). Fluorescein and indocyanine green angiographic signs (angiographic scores given by a masked observer) were analysed in the 3 groups and compared to the "cream-coloured" fundus lesions. RESULTS Fifteen out of the 742 patients (2.0 %) seen at La Source Eye Centre during the time period considered presented BC and were included in the study. In the "early disease group" fluorescein and ICG angiography showed more severe choroidal than retinal involvement with respective scores of 3 +/- 0.79 (ICG) and 2 +/- 1.17 (FA) while there were few depigmented fundus lesions to be seen (score 1 +/- 0.27). The choroidal involvement responded well to systemic corticosteroids +/- immunosuppressive therapy (scores in groups 2 and 3 = 1.2 and 0.75), while retinal disease was stabilised at best (scores in groups 2 and 3 = 2.2. and 2.4) and depigmented fundus lesions increased (scores in groups 2 and 3 = 2.8 and 3). CONCLUSION The evolution and response to therapy of retinal and choroidal disease in Birdshot Chorioretinopathy have a different course with choroidal disease responding well to therapy while retinal disease is more resistant, possibly explaining the slow deterioration of functional parameters despite therapy. The increase of "cream-coloured" fundus lesions despite good choroidal response to therapy could be explained by depigmentation left behind after resolution of choroidal stromal granulomas, a hypothesis recently confirmed by an autopsy case of Birdshot Chorioretinopathy.
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Indocyanine green angiography in Birdshot Chorioretinopathy
Ophthalmology, 1999Co-Authors: Christine Fardeau, Carl P Herbort, Nathalie Kullmann, Gabriel Quentel, Phuc LehoangAbstract:Abstract Objective Birdshot Chorioretinopathy (BC) is an ocular inflammatory disease involving both the retina and the choroid. The study goal was to evaluate indocyanine green angiographic features in BC to assess choroidal involvement. Design Retrospective, observational case series. Participants Fifty-two patients with BC documented with at least 1 concomitant fluorescein and indocyanine green angiogram. Intervention Indocyanine green angiography (ICGA) was performed according to a standard protocol used for inflammatory disorders. Main outcome measure Indocyanine green angiographic signs were correlated with fundus photographs, fluorescein angiography, degree of inflammatory activity, and stage of disease. Results In active disease, three main features were observed. The principal finding, found in 100% of patients, was the presence of hypofluorescent dark dots during the intermediate phase of angiography; their evolutionary pattern was twofold, becoming either isofluorescent or remaining hypofluorescent at the late phase of angiography. The other two signs were fuzzy, indistinct choroidal vessels and late-diffuse choroidal hyperfluorescence. In chronic longlasting disease, the characteristic finding was the presence of hypofluorescent dark dots that persisted in the late phase of disease and is theorized to correspond either to chorioretinal atrophy (irregular geographic pattern) or to persistent choroidal granulomas (round oval form). Conclusions Consistent ICGA findings in 52 patients allowed the authors to establish a fairly precise ICGA semiology for BC. This procedure enabled the authors to assess choroidal involvement, and, in selected cases, it also was found to be of diagnostic help and useful to monitor therapeutic intervention.
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Prolonged retinal arterio-venous circulation time by fluorescein but not by indocyanine green angiography in Birdshot Chorioretinopathy
Ocular Immunology and Inflammation, 1997Co-Authors: Yan Guex-crosier, Carl P HerbortAbstract:Purpose: To compare retinal arterio-venous circulation time by fluorescein (FA) and indocyanine green angiography (ICGA) in Birdshot Chorioretinopathy. Methods: We analyzed prolonged retinal arterio-venous fluorescein transit time, a known feature in Birdshot Chorioretinopathy and correlated it with ICGA findings in four consecutive patients. Results: Mean retinal arterio-venous fluorescein circulation time was 31.1 ± 5.2 seconds, a transit time significantly longer than in a group of ten patients with sarcoid-osis (9.45 ± 3.36 sec., p
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prolonged retinal arterio venous circulation time by fluorescein but not by indocyanine green angiography in Birdshot Chorioretinopathy
Ocular Immunology and Inflammation, 1997Co-Authors: Yan Guexcrosier, Carl P HerbortAbstract:Purpose: To compare retinal arterio-venous circulation time by fluorescein (FA) and indocyanine green angiography (ICGA) in Birdshot Chorioretinopathy. Methods: We analyzed prolonged retinal arterio-venous fluorescein transit time, a known feature in Birdshot Chorioretinopathy and correlated it with ICGA findings in four consecutive patients. Results: Mean retinal arterio-venous fluorescein circulation time was 31.1 ± 5.2 seconds, a transit time significantly longer than in a group of ten patients with sarcoid-osis (9.45 ± 3.36 sec., p<0.0001) and in a group of three cases with Vogt-Koyanagi-Harada disease (7.0 ± 1,i sec., p<0.0001). Conclusion: Prolonged fluorescein arterio-venous transit time seems to be a characteristic feature of Birdshot Chorioretinopathy that does however not reflect the actual intravas-cular hemodynamic situation but diffuse blood-retinal barrier damage allow-ing exudation, slow gradual tissue impregnation and delayed venous reab-sorption of small molecules like fluorescein.
Ralph D Levinson - One of the best experts on this subject based on the ideXlab platform.
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HLA-A29 and Birdshot Chorioretinopathy.
Ocular immunology and inflammation, 2011Co-Authors: Antoine P Brézin, Dominique Monnet, Jacques H.m. Cohen, Ralph D LevinsonAbstract:Birdshot Chorioretinopathy primarily affects patients of European descent. At least 96%, if not all patients, are HLA-A29 carriers. HLA-A*29:01 and HLA-A*29:02, the two main subtypes of HLA-A29, differ only by a single mutation. In the general population HLA-A*29:02 is most frequent in whites, while HLA-A*29:01 is more frequent in Asians. The differential distribution of HLA-A*29:01 and HLA-A*29:02 has been actively debated as an explanation for the selective development of the disease in patients of European descent, but is no longer a valid argument. Another factor, probably not HLA linked, is either protective in Asians and in Africans or, conversely, triggers an autoimmune reactivity that is possibly present in whites and absent in Asians and in Africans. HLA-A*29:02 transgenic mice in which a spontaneous posterior uveitis is observed after 6 months of age provide further evidence that the HLA-A29 molecule plays a role in the pathogenesis of the disease.
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Extraocular manifestations of Birdshot Chorioretinopathy in 118 French patients.
Presse medicale (Paris France : 1983), 2010Co-Authors: Christian Pagnoux, Dominique Monnet, Antoine P Brézin, Ralph D Levinson, Alfred Mahr, Achille Aouba, Alice Bérezné, Pascal Cohen, Loïc GuillevinAbstract:Summary Introduction Published studies on Birdshot Chorioretinopathy (BCR) did not provide definitive information on possibly associated extraocular manifestations. Methods Single-center cross-sectional analysis of extraocular manifestations in a cohort of patients with BCR. Results Since 2002, 118 patients (45 men, 73 women) were enrolled. Their mean age was 51.5 years at diagnosis. The most common features of their medical histories were: hypertension (32 patients), drug allergy (19), sinusitis (17), thyroid disease (12), otitis media (11), asthma (11); diabetes (10); cancer (8); psoriasis (5); monoclonal gammopathies (3). At the time of disease onset, arthralgias were noted in 23, ENT manifestations in 26, Raynaud's phenomenon in 6, headaches in 10, psoriasis in 3 others. Between diagnosis and cross-sectional evaluation visits, only the frequency of hypertension has increased significantly (11 additional patients). Discussion and conclusions No predominant extraocular manifestation of BCR was identified in our patients. Their ongoing follow-up may yet discern whether BCR is definitively eye-restricted.
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Contrast Sensitivity Among Patients with Birdshot Chorioretinopathy
American journal of ophthalmology, 2008Co-Authors: Peter J Kappel, Dominique Monnet, Antoine P Brézin, Ralph D Levinson, Gary N HollandAbstract:Purpose To assess contrast sensitivity in patients with Birdshot Chorioretinopathy; to identify relationships between contrast sensitivity, other measures of visual function, clinical findings, and quality of life. Design Single-center, cross-sectional study. Methods We measured contrast sensitivity in 63 patients (126 eyes) at four spatial frequencies (3, 6, 12, 18 cycles/degree [cpd]) using the CSV-1000E instrument (VectorVision, Greenville, Ohio, USA). Abnormal contrast sensitivity was defined as two standard deviations below the mean for population norms. Results at spatial frequency 12 cpd were compared to the following parameters in per-eye analyses: best-corrected visual acuity (BCVA); presence of eight specified symptoms; color vision; visual field parameters (foveal threshold, mean deviation); and optical coherence tomography parameters (central macular thickness, loss of the third highly reflective band). Results were compared to the National Eye Institute Visual Function Questionnaire (VFQ)-25 in per-patient analyses. Results were adjusted for age, disease duration, treatment, BCVA, and lens status. Results Contrast sensitivity (spatial frequency 12 cpd) was abnormal in 99 eyes (92%), and was related to poor BCVA ( P = .0004) and the symptom of poor contrast sensitivity ( P = .025). Among 38 eyes with normal BCVA (≥1.0), 31 eyes (82%) had abnormal contrast sensitivity. There was a positive correlation between contrast sensitivity in better eyes and the VFQ-25 composite scores ( r = 0.51; P Conclusion Decreased contrast sensitivity is common in patients with Birdshot Chorioretinopathy and may occur in the absence of other visual changes. Contrast sensitivity may be a useful measure for clinical studies of Birdshot Chorioretinopathy and for monitoring patients with the disease.
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Longitudinal cohort study of patients with Birdshot Chorioretinopathy. V. Quality of life at baseline.
American journal of ophthalmology, 2008Co-Authors: Ralph D Levinson, Dominique Monnet, Gary N Holland, Peter R. Gutierrez, Antoine P BrézinAbstract:Purpose To describe results of a vision-specific quality-of-life (QOL) questionnaire at baseline examination of 80 subjects in a longitudinal cohort study of Birdshot Chorioretinopathy and to identify relationships between these results and measures of visual function. Design Single-center, cross-sectional study. Methods The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was administered to all subjects. NEI VFQ-25 composite scores were compared with best-corrected visual acuity (BCVA), symptoms, color confusion scores, and parameters from automated perimetry (mean deviation [MD], total deviation) for the better eye (with regard to the factor being studied) of each subject. Selected measures of visual function were compared with the 12 subscale scores. Results The median composite score was 76.8 (range, 7.8 to 99.4). Worse composite scores were related to decreased BCVA ( P = .030), but the correlation was weak, and subjects with normal BCVA (≥ 1.0) in both eyes had composite scores as low as 37.7. Lower composite scores were related to symptoms of blurry vision ( P = .0097), nyctalopia ( P = .002), vibrating vision ( P = .014), and poor peripheral vision ( P = .007). Lower composite scores were related to worse MD ( P = .005). Although nyctalopia and MD are related, each was associated with composites scores on multivariate analysis. Nyctalopia was associated with the largest number of subscales having decreased scores. Conclusions Birdshot Chorioretinopathy has an impact on vision-specific QOL. BCVA alone does not explain decreased vision-specific QOL in our cohort; changes in automated perimetry and symptoms seem to be important contributors to alterations in QOL that are independent of BCVA changes.
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Combination of KIR and HLA gene variants augments the risk of developing Birdshot Chorioretinopathy in HLA-A*29-positive individuals.
Genes and immunity, 2008Co-Authors: Ralph D Levinson, Dominique Monnet, Antoine P Brézin, Gary N Holland, Lihui Luo, Thierry Tabary, L Zhao, David W. Gjertson, Elaine F. ReedAbstract:Combination of KIR and HLA gene variants augments the risk of developing Birdshot Chorioretinopathy in HLA-A*29 -positive individuals
Gary N Holland - One of the best experts on this subject based on the ideXlab platform.
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Contrast Sensitivity Among Patients with Birdshot Chorioretinopathy
American journal of ophthalmology, 2008Co-Authors: Peter J Kappel, Dominique Monnet, Antoine P Brézin, Ralph D Levinson, Gary N HollandAbstract:Purpose To assess contrast sensitivity in patients with Birdshot Chorioretinopathy; to identify relationships between contrast sensitivity, other measures of visual function, clinical findings, and quality of life. Design Single-center, cross-sectional study. Methods We measured contrast sensitivity in 63 patients (126 eyes) at four spatial frequencies (3, 6, 12, 18 cycles/degree [cpd]) using the CSV-1000E instrument (VectorVision, Greenville, Ohio, USA). Abnormal contrast sensitivity was defined as two standard deviations below the mean for population norms. Results at spatial frequency 12 cpd were compared to the following parameters in per-eye analyses: best-corrected visual acuity (BCVA); presence of eight specified symptoms; color vision; visual field parameters (foveal threshold, mean deviation); and optical coherence tomography parameters (central macular thickness, loss of the third highly reflective band). Results were compared to the National Eye Institute Visual Function Questionnaire (VFQ)-25 in per-patient analyses. Results were adjusted for age, disease duration, treatment, BCVA, and lens status. Results Contrast sensitivity (spatial frequency 12 cpd) was abnormal in 99 eyes (92%), and was related to poor BCVA ( P = .0004) and the symptom of poor contrast sensitivity ( P = .025). Among 38 eyes with normal BCVA (≥1.0), 31 eyes (82%) had abnormal contrast sensitivity. There was a positive correlation between contrast sensitivity in better eyes and the VFQ-25 composite scores ( r = 0.51; P Conclusion Decreased contrast sensitivity is common in patients with Birdshot Chorioretinopathy and may occur in the absence of other visual changes. Contrast sensitivity may be a useful measure for clinical studies of Birdshot Chorioretinopathy and for monitoring patients with the disease.
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Longitudinal cohort study of patients with Birdshot Chorioretinopathy. V. Quality of life at baseline.
American journal of ophthalmology, 2008Co-Authors: Ralph D Levinson, Dominique Monnet, Gary N Holland, Peter R. Gutierrez, Antoine P BrézinAbstract:Purpose To describe results of a vision-specific quality-of-life (QOL) questionnaire at baseline examination of 80 subjects in a longitudinal cohort study of Birdshot Chorioretinopathy and to identify relationships between these results and measures of visual function. Design Single-center, cross-sectional study. Methods The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was administered to all subjects. NEI VFQ-25 composite scores were compared with best-corrected visual acuity (BCVA), symptoms, color confusion scores, and parameters from automated perimetry (mean deviation [MD], total deviation) for the better eye (with regard to the factor being studied) of each subject. Selected measures of visual function were compared with the 12 subscale scores. Results The median composite score was 76.8 (range, 7.8 to 99.4). Worse composite scores were related to decreased BCVA ( P = .030), but the correlation was weak, and subjects with normal BCVA (≥ 1.0) in both eyes had composite scores as low as 37.7. Lower composite scores were related to symptoms of blurry vision ( P = .0097), nyctalopia ( P = .002), vibrating vision ( P = .014), and poor peripheral vision ( P = .007). Lower composite scores were related to worse MD ( P = .005). Although nyctalopia and MD are related, each was associated with composites scores on multivariate analysis. Nyctalopia was associated with the largest number of subscales having decreased scores. Conclusions Birdshot Chorioretinopathy has an impact on vision-specific QOL. BCVA alone does not explain decreased vision-specific QOL in our cohort; changes in automated perimetry and symptoms seem to be important contributors to alterations in QOL that are independent of BCVA changes.
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Combination of KIR and HLA gene variants augments the risk of developing Birdshot Chorioretinopathy in HLA-A*29-positive individuals.
Genes and immunity, 2008Co-Authors: Ralph D Levinson, Dominique Monnet, Antoine P Brézin, Gary N Holland, Lihui Luo, Thierry Tabary, L Zhao, David W. Gjertson, Elaine F. ReedAbstract:Combination of KIR and HLA gene variants augments the risk of developing Birdshot Chorioretinopathy in HLA-A*29 -positive individuals
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Longitudinal cohort study of patients with Birdshot Chorioretinopathy. III. Macular imaging at baseline.
American journal of ophthalmology, 2007Co-Authors: Dominique Monnet, Ralph D Levinson, Gary N Holland, Lamine Haddad, Antoine P BrézinAbstract:Purpose To describe optical coherence tomography (OCT) and fluorescein angiography (FA) parameters at baseline examination of 80 subjects (160 eyes) in a longitudinal cohort study of Birdshot Chorioretinopathy and to compare these parameters with measures of visual function and clinical findings. Design Single-center cross-sectional study. Methods Comparisons were made between OCT and FA parameters. The existence of relationships was examined between three OCT parameters (macular thickness, status of the third highly reflective band [HRB], epiretinal membrane) and the following factors: best-corrected visual acuity (BCVA), symptoms, color confusion score (CCS), vitreous haze, retinal vasculitis, and Birdshot lesion characteristics. Grade of vascular leakage by FA was compared with the same factors. Results There was not good agreement between macular edema identified by OCT vs FA (κ, 0.37). On multivariate analyses, decreased BCVA was related to abnormal macular thickness ( P P P = .034). When compared with macular parameters, symptoms were related most closely to loss of the third HRB. There were no strong relationships between Birdshot lesion characteristics and macular parameters. Conclusions Macular changes are reflected in reduced BCVA and may provide insight into mechanisms of some visual symptoms. Loss of the third HRB was the parameter most commonly related to other disease factors. Birdshot Chorioretinopathy can result in macular thinning with central vision loss. FA and OCT each may be useful tests for the evaluation of the macula in patients with Birdshot Chorioretinopathy.
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Longitudinal Cohort Study of Patients with Birdshot Chorioretinopathy. IV. Visual Field Results at Baseline
American journal of ophthalmology, 2007Co-Authors: Lynn K Gordon, Dominique Monnet, Antoine P Brézin, Gary N Holland, Ralph D LevinsonAbstract:Purpose To describe visual field parameters at baseline examination of 80 participants in a longitudinal cohort study of Birdshot Chorioretinopathy and to identify relationships between these parameters and visual acuity, symptoms, clinical findings, and results of laboratory tests. Design Single-center cross-sectional study. Methods Standardized Fastpac, full-threshold Humphrey 30-2 (Carl Zeiss Meditec, Dublin, California, USA) visual field studies were performed for both eyes of all patients. A standardized protocol identified foveal threshold and mean deviation, specified categories of total deviation, and assigned visual field pattern descriptors. These parameters were compared with best-corrected visual acuity (BCVA), symptoms, color confusion score (CCS), cataract, vitreous inflammatory reactions, retinal vasculitis, Birdshot lesion characteristics, and ocular coherence tomography (OCT) and fluorescein angiography parameters. Results Each visual field parameter was closely related to the others, although mean deviation could be abnormal in the presence of a near normal foveal threshold. Mean deviation was related to BCVA, but the correlation was moderate (the Spearman correlation, −0.55; P Conclusions Patients with Birdshot Chorioretinopathy may have a variety of visual field abnormalities, even with normal BCVA. Abnormalities seem to be associated with retinal damage. Automated visual field testing may provide objective measures for monitoring disease activity.
Jay S. Duker - One of the best experts on this subject based on the ideXlab platform.
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Birdshot Chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment
Orphanet Journal of Rare Diseases, 2016Co-Authors: Evangelos Minos, Sue Southworth, Annie Folkard, Pearse A. Keane, Philip I. Murray, Jay S. Duker, Robert J. Barry, Alastair K DennistonAbstract:Birdshot Chorioretinopathy (BCR) is a rare form of chronic, bilateral, posterior uveitis with a distinctive clinical phenotype, and a strong association with HLA-A29. It predominantly affects people in middle age. Given its rarity, patients often encounter delays in diagnosis leading to delays in adequate treatment, and thus risking significant visual loss. Recent advances have helped increase our understanding of the underlying autoimmune mechanisms involved in disease pathogenesis, and new diagnostic approaches such as multimodality imaging have improved our ability to both diagnose and monitor disease activity. Whilst traditional immunosuppressants may be effective in BCR, increased understanding of immune pathways is enabling development of newer treatment modalities, offering the potential for targeted modulation of immune mediators. In this review, we will discuss current understanding of BCR and explore recent developments in diagnosis, monitoring and treatment of this disease. Synonyms for BCR: Birdshot Chorioretinopathy, Birdshot retinochoroiditis, Birdshot retino-choroidopathy, Vitiliginous choroiditis. Orphanet number: ORPHA179 OMIM: 605808.
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Visual response and anatomical changes on sequential spectral-domain optical coherence tomography in Birdshot Chorioretinopathy treated with local corticosteroid therapy
International Journal of Retina and Vitreous, 2016Co-Authors: Marisa Gobuty, Mehreen Adhi, Sarah P. Read, Jay S. DukerAbstract:Background Birdshot Chorioretinopathy is a chronic bilateral inflammatory disease of unknown etiology characterized by bilateral retinal vasculitis, mild to moderate vitritis, retinal vascular leakage, cystoid macular edema (CME), and typical “Birdshot” chorioretinal lesions. Typically, patients with Birdshot Chorioretinopathy are treated with systemic immunosuppressive and/or corticosteroid therapy in an effort to minimize loss of vision. Spectral-domain OCT (SD-OCT) has shown regional or generalized photoreceptor loss in addition to both retinal as well as choroidal thinning in these patients. The present study describes anatomical changes of the retina and alterations in choroidal thickness and vasculature on sequential spectral-domain optical coherence tomography (SD-OCT) in 4 patients with Birdshot Chorioretinopathy treated with local corticosteroids. Methods A retrospective observational case series identified 4 consecutive patients (8 eyes) at New England Eye Center, Boston diagnosed with Birdshot Chorioretinopathy according to the research criteria of the international consensus conference that were managed by a single retina specialist and treated exclusively with local corticosteroid therapy (intravitreal/sub-tenon injections) without systemic immunosuppression. All patients underwent longitudinal SD-OCT imaging with both the 512 × 128 cube scan and the 1-line raster protocol. A chart review was performed to review the visual response to treatment. Two independent observers analyzed sequential SD-OCT images for retinal parameters such as occurrence of CME at any time during the course of disease, presence of retinal thinning and presence of hyper-reflective foci within the retina, and choroidal parameters including its thickness and its vasculature. Results Mean age of the patients at diagnosis was 47 years (26–60 years). Mean duration of follow-up was 96 months. All patients were HLA-A29 positive. Visual acuity remained stable in 75 % of eyes, 63 % eyes had central retinal thinning, 75 % eyes had hyper reflective foci within the retina and 75 % eyes had CME during follow-up. Mean total sub-foveal choroidal thickness of all 8 eyes at the time of the last SD-OCT was significantly lower than at initial SD-OCT (p = 0.03). Conclusions This case series suggests that treatment with local corticosteroids may have good visual outcome despite retinal and choroidal thinning. Future longitudinal studies are necessary to further determine the benefits of local corticosteroid therapy.
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Visual response and anatomical changes on sequential spectral-domain optical coherence tomography in Birdshot Chorioretinopathy treated with local corticosteroid therapy
International journal of retina and vitreous, 2016Co-Authors: Marisa Gobuty, Mehreen Adhi, Sarah P. Read, Jay S. DukerAbstract:Birdshot Chorioretinopathy is a chronic bilateral inflammatory disease of unknown etiology characterized by bilateral retinal vasculitis, mild to moderate vitritis, retinal vascular leakage, cystoid macular edema (CME), and typical “Birdshot” chorioretinal lesions. Typically, patients with Birdshot Chorioretinopathy are treated with systemic immunosuppressive and/or corticosteroid therapy in an effort to minimize loss of vision. Spectral-domain OCT (SD-OCT) has shown regional or generalized photoreceptor loss in addition to both retinal as well as choroidal thinning in these patients. The present study describes anatomical changes of the retina and alterations in choroidal thickness and vasculature on sequential spectral-domain optical coherence tomography (SD-OCT) in 4 patients with Birdshot Chorioretinopathy treated with local corticosteroids. A retrospective observational case series identified 4 consecutive patients (8 eyes) at New England Eye Center, Boston diagnosed with Birdshot Chorioretinopathy according to the research criteria of the international consensus conference that were managed by a single retina specialist and treated exclusively with local corticosteroid therapy (intravitreal/sub-tenon injections) without systemic immunosuppression. All patients underwent longitudinal SD-OCT imaging with both the 512 × 128 cube scan and the 1-line raster protocol. A chart review was performed to review the visual response to treatment. Two independent observers analyzed sequential SD-OCT images for retinal parameters such as occurrence of CME at any time during the course of disease, presence of retinal thinning and presence of hyper-reflective foci within the retina, and choroidal parameters including its thickness and its vasculature. Mean age of the patients at diagnosis was 47 years (26–60 years). Mean duration of follow-up was 96 months. All patients were HLA-A29 positive. Visual acuity remained stable in 75 % of eyes, 63 % eyes had central retinal thinning, 75 % eyes had hyper reflective foci within the retina and 75 % eyes had CME during follow-up. Mean total sub-foveal choroidal thickness of all 8 eyes at the time of the last SD-OCT was significantly lower than at initial SD-OCT (p = 0.03). This case series suggests that treatment with local corticosteroids may have good visual outcome despite retinal and choroidal thinning. Future longitudinal studies are necessary to further determine the benefits of local corticosteroid therapy.
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RETINAL AND CHOROIDAL VASCULATURE IN Birdshot Chorioretinopathy ANALYZED USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.
Retina (Philadelphia Pa.), 2015Co-Authors: Talisa E De Carlo, Marco A. Bonini Filho, Mehreen Adhi, Jay S. DukerAbstract:Purpose:To describe retinal and choroidal vascular changes in eyes with Birdshot Chorioretinopathy using optical coherence tomography angiography.Methods:Patients underwent imaging using the AngioVue prototype software of the RTVue XR spectral domain optical coherence tomography device (Optovue, Inc
Yan Guexcrosier - One of the best experts on this subject based on the ideXlab platform.
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prolonged retinal arterio venous circulation time by fluorescein but not by indocyanine green angiography in Birdshot Chorioretinopathy
Ocular Immunology and Inflammation, 1997Co-Authors: Yan Guexcrosier, Carl P HerbortAbstract:Purpose: To compare retinal arterio-venous circulation time by fluorescein (FA) and indocyanine green angiography (ICGA) in Birdshot Chorioretinopathy. Methods: We analyzed prolonged retinal arterio-venous fluorescein transit time, a known feature in Birdshot Chorioretinopathy and correlated it with ICGA findings in four consecutive patients. Results: Mean retinal arterio-venous fluorescein circulation time was 31.1 ± 5.2 seconds, a transit time significantly longer than in a group of ten patients with sarcoid-osis (9.45 ± 3.36 sec., p<0.0001) and in a group of three cases with Vogt-Koyanagi-Harada disease (7.0 ± 1,i sec., p<0.0001). Conclusion: Prolonged fluorescein arterio-venous transit time seems to be a characteristic feature of Birdshot Chorioretinopathy that does however not reflect the actual intravas-cular hemodynamic situation but diffuse blood-retinal barrier damage allow-ing exudation, slow gradual tissue impregnation and delayed venous reab-sorption of small molecules like fluorescein.