Peripheral Capillary Non-perfusion in Birdshot Retinochoroiditis: A Novel Finding on Ultra-widefield Fluorescein Angiography

ABSTRACT

Purpose: To report a novel peripheral finding in patients with Birdshot retinochoroiditis (BRC) using ultra-widefield fluorescein angiography (UWFFA).

Methods: UWFFA images from 90 patients diagnosed with BRC were reviewed. All images were evaluated for the presence of peripheral retinal ischemic changes and ischemia-related complications.

Findings: Thirty-six eyes of 24 patients showed features of peripheral ischemia, including 18 eyes with peripheral capillary non-perfusion (CNP), 5 eyes with teleangectasias, with or without microaneurysms, and 13 eyes with both teleangectasias and CNP. None of the 36 eyes with peripheral ischemic changes developed retinal neovascularization following the diagnosis of peripheral ischemia.

Conclusions: Peripheral ischemia may present in eyes with chronic inflammation as seen in BRC but does not seem to progress to neovascular complications. This is likely to be more common than suspected and has now become evident following the advent of UWFFA.

Abbreviations: HLA-A29: Human leukocyte antigen - A29; FFA: Fundus fluorescein angiography; OCT: Optical coherence tomography; ICGA: Indocyanine green angiography; UWF: Ultra-wide field; UWFFA: Ultra-wide field fluorescein angiography; CNP: Capillary non-perfusion

KEYWORDS:

• Birdshot retinochoroiditis
• ultra-widefield fluorescein angiography
• peripheral capillary non-perfusion
• teleangectasias
• retinal neovascularization

Availability of data and materials

All the data and images pertaining to the cases are available with the corresponding author.

Authors’ contributions

IT, SA and AA performed data collection and analysis, and contributed to literature review and preparation of the manuscript. CP provided the concept and design, intellectual content and critical review of the manuscript. All authors read and approved the final manuscript.

Competing interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Consent

An informed consent was taken from patients.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.