Birdshot Chorioretinopathy: Resistant versus Responsive

ABSTRACT

Purpose

To search findings that can explain the heterogeneity between Resistant and Responsive patients with birdshot chorioretinopathy.

Patients and Methods

This was a retrospective observational case series on “Responsive” versus “Resistant” birdshot chorioretinopathy

Results

One-hundred-eighty and Ninety-nine patients were included in the Responsive and Resistant groups respectively. Multivariate analysis of paraclinical variables at the first visit demonstrated that mean deviation (p = .04), pattern standard deviation (p < .001), optic nerve head leakage (p = .012), large vessel leakage and staining (p = .01), and macular small vessel leakage (p = .03) were statistically significantly different between the two groups; however, at the visit preceding successful therapy, only macular small vessel leakage (p = .01) was statistically significantly different between the two groups

Conclusion

.Small vessel leakage in the macular area and/or optic nerve head leakage at the earliest visit might be risk factors for resistant birdshot chorioretinopathy.

KEYWORDS:

• Biologic response modifier
• birdshot chorioretinopathy
• BSCR
• corticosteroid
• electroretinography
• fluorescein angiography
• immunomodulatory therapy
• indocyanine green angiography
• retinal vasculitis
• visual field
• short wavelength automated perimetry

Highlights

• In a step-ladder approach, less potent medications are tried first in the treatment of patients with birdshot chorioretinopathy (BSCR).

• Some BSCR patients will need intravenous therapy such as conventional, biologic response modifiers agents, and intravenous immunoglobulin (IVIg) or even intravitreal corticosteroid implants.

• Small vessels leakage in the macular area and optic nerve head on fluorescein angiography at the first visit are the risk factors indicating that the BSCR patient may eventually need intravenous IMT or intravitreal corticosteroid implant (Resistant BSCR).

Acknowledgments

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Compliance with ethics guidelines

This study was approved by the New England Institutional Review Board, which has issued a waiver of informed consent for the retrospective chart review analysis.

This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments.

All participants provided consent for publication if any identifying information is included in the manuscript.

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Additional information

Funding

This trial was supported by an investigator-initiated research grant from Mallinckrodt (Staines-upon-Thames, United Kingdom). Mallinckrodt had no role in the design or conduct of this research nor production of this manuscript.