1. History
  2. Exam
  3. Photos
  4. Diagnosis
  5. Teaching Points
  6. Comments

Case 121 Teaching Points

  • Affects women more than men, usually in their 4th-6th┬ádecades
  • Patients present with blurred vision secondary to macular edema and floaters caused by vitritis, but typically visual acuity is better than 20/60 at presentation
  • Disease is always bilateral and usually symmetric
  • Exam findings include vitritis, classic discrete creamy-white "birdshot" choroidal infiltrates, optic disc edema, cystoid macular edema
  • Mild anterior chamber inflammation may be present but there typically is a lack of conjunctival injection
  • Testing for the HLA-A29 gene is imperative to making the diagnosis (sensitivity 96%, specificity 93%)
  • Fluorescein angiography may demonstrate macular leakage, which is associated with a poorer prognosis
  • Long-term course of exacerbations and remissions
  • Decreased visual acuity typically results from cystoid macular edema - corticosteroids and other immunosuppressants have been used for treatment, but no randomized controlled clinical trials are available

References

Ryan SJ, Rao NA. Birdshot retinochoroidopathy. In: Ryan SJ, ed. Retina, Vol 2, 4th ed. 2006. Elsevier Mosby pp 1763-1770.

Monnet D, Brezin AP. Birdshot chorioretinopathy. Curr Opin Ophthalmol 2006;17:545-550.

Last Modified: Wednesday, 28-May-2008 14:37:51 EDT