Reappraisal of birdshot retinochoroiditis

A  paper entitled “Reappraisal of birdshot retinochoroiditis (BRC): a global approach.” has just been published by M Papdia and C P Herbort.

Carl Herbort is a well known Swiss Ophthalmologist, and friend of Birdshot Uveitis Society.  The study aimed to readjust the appraisal of birdshot retinochoroiditis (BRC) in light of a global approach.  It confirms what we at Birdshot Uveitis Society, have thought for a long time.

1) Some types of Birdshot are easier to treat than other types depending on whether the choroid or retina are affected.

2) For a successful diagnosis it is crucially important to get the right tests.

3) You can even be diagnosed with Birdshot before the pigmented lesions develop.

The review showed that Birdshot Retinochoroditis is a granulomatous uveitis, and mutton-fat KPs do not exclude the disease.

The following tests are crucial for the accurate diagnosis of the disease.

1) Indocyanine green angiography is crucial to allow early diagnosis and to monitor the evolution of choroiditis.

2) Perimetry (Fields tests) is an essential investigation for diagnosis and follow-up.  Anomalies in the Fieldtests were noted in all patients at presentation.

3) Cystoid macular edema (CMO) is less frequent than previously thought.

4) Repeat fluorescein and indocyanine green angiographic flurosceins indicate that choroiditis responded readily to therapy, but retinitis was relatively resistant to therapy.

In 92 % of cases, fluorescein findings included disc hyperfluorescence, retinal vasculitis of large vessels, and leakage from medium-sized and small vessels.

In all patients, a (pseudo)-delay was noted in the arterio-venous circulation time which reflected massive capillary leakage.

At presentation, all patients exhibited indocyanine green angiographic signs, including hypofluorescent dark dots, vessel fuzziness, and areas of diffuse late hyperfluorescence.

This allowed early diagnosis in 3/19 patients (16 %) without birdshot fundus lesions at presentation.

The published paper can be found at: Reappraisal of birdshot retinochoroiditis (BRC): a global approach..

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