Oren Tomkins-Netzer1, Simon R J Taylor2, Sue Lightman1. 1. Uveitis Service, Moorfields Eye Hospital, London, England 2Department of Ophthalmology, Royal Surrey County Hospital, Guildford, England 3Institute of Ophthalmology, University College of London, London, England. 2. Uveitis Service, Moorfields Eye Hospital, London, England 2Department of Ophthalmology, Royal Surrey County Hospital, Guildford, England 4Division of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, England.
Abstract
IMPORTANCE: Birdshot chorioretinopathy is a chronic intraocular inflammatory disease with no uniform method to document long-term disease progression or response to treatment. OBJECTIVE: To examine the long-term visual, clinical, and anatomic outcomes of patients with birdshot chorioretinopathy. DESIGN, SETTING, AND PARTICIPANTS: A retrospective evaluation of 46 patients with birdshot chorioretinopathy treated at Moorfields Eye Hospital, London, England, was conducted. Medical records for a 19-year period (1993-2012) were reviewed. EXPOSURES: Patients received no treatment, short-term (≤1 year) treatment including local or systemic corticosteroids, or long-term (>1 year) treatment including systemic corticosteroids and second-line immunosuppressive agents. MAIN OUTCOMES AND MEASURES: Details regarding clinical and anatomic outcome, including best-corrected visual acuity, and visual field indices were evaluated. RESULTS: Ninety-two eyes of 46 patients were monitored for a mean (SE) of 57.2 (5.8) months (445 eye-years, 17% follow-up of ≥10 years). Patients maintained a steady best-corrected visual acuity throughout the follow-up period. Some clinical indices correlated with transient worse best-corrected visual acuity, including presence of cataract (P = .05), foveal leakage on fluorescein angiography (P = .04), and increased central retinal thickness (P = .02). Serial visual field studies demonstrated that patients who received only short-term treatment had a worsening of their pattern standard deviation with time (Spearman correlation, 0.57; P = .003); for those who received long-term treatment, the pattern standard deviation remained stable (Spearman correlation, -0.24; P = .26). CONCLUSIONS AND RELEVANCE: Our results suggest that central visual acuity can be maintained long term in patients with birdshot chorioretinopathy. Those who receive long-term immunosuppression appear to maintain better peripheral visual fields compared with patients who receive short-term treatment.
IMPORTANCE: Birdshot chorioretinopathy is a chronic intraocular inflammatory disease with no uniform method to document long-term disease progression or response to treatment. OBJECTIVE: To examine the long-term visual, clinical, and anatomic outcomes of patients with birdshot chorioretinopathy. DESIGN, SETTING, AND PARTICIPANTS: A retrospective evaluation of 46 patients with birdshot chorioretinopathy treated at Moorfields Eye Hospital, London, England, was conducted. Medical records for a 19-year period (1993-2012) were reviewed. EXPOSURES: Patients received no treatment, short-term (≤1 year) treatment including local or systemic corticosteroids, or long-term (>1 year) treatment including systemic corticosteroids and second-line immunosuppressive agents. MAIN OUTCOMES AND MEASURES: Details regarding clinical and anatomic outcome, including best-corrected visual acuity, and visual field indices were evaluated. RESULTS: Ninety-two eyes of 46 patients were monitored for a mean (SE) of 57.2 (5.8) months (445 eye-years, 17% follow-up of ≥10 years). Patients maintained a steady best-corrected visual acuity throughout the follow-up period. Some clinical indices correlated with transient worse best-corrected visual acuity, including presence of cataract (P = .05), foveal leakage on fluorescein angiography (P = .04), and increased central retinal thickness (P = .02). Serial visual field studies demonstrated that patients who received only short-term treatment had a worsening of their pattern standard deviation with time (Spearman correlation, 0.57; P = .003); for those who received long-term treatment, the pattern standard deviation remained stable (Spearman correlation, -0.24; P = .26). CONCLUSIONS AND RELEVANCE: Our results suggest that central visual acuity can be maintained long term in patients with birdshot chorioretinopathy. Those who receive long-term immunosuppression appear to maintain better peripheral visual fields compared with patients who receive short-term treatment.
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