birdshot choroidopathy

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▪ What is (birdshot choroidopathy)? DR JOHN 2020
It is a Birdshot uveitis is characterized by: -
a) yellow-white choroidal lesions ¼ to ½ optic disc diameter.
b) clustered around the optic nerve and the posterior pole, radiating towards the periphery.
c) nearly always involving inferior and nasal peripapillary area.
d) It is a pattern similar to the gunshot spatter from birdshot
▪ Causes: -
Unknown ( autoimmune)
▪ Symptoms: -
1) Nyctalopia ( poor vision in dim / dark )
2) Floaters
3) Flashes of light (Photopsia)
4) Dyschromatopsia
▪ Diagnostic criteria:
An International Workshop held at UCLA in 2002 established a set of diagnostic criteria.
• Required Characteristics Included:
1) Disease in both eyes (bilateral)
2) ≥ 3 peripapillary birdshot lesions (cream-colored, irregular or elongated choroidal lesions with
long axis radiating from optic disc)
3) > 1+ anterior vitreous cells
4) > 2+ vitreous haze
• Supportive Findings:
1) HLA-A29 (+ve)
2) Retinal vasculitis
3) Cystoid Macular Oedema (CME)
▪ Investigations: -
1) FFA / (area of Hypoflurescence, doesn’t typically highlight spots)
2) ICG (areas of Hypoflurescence) , shows spots more numerous .
3) VF (scattered, arcuate scotoma, enlarged blind spot)
4) ERG (marked decreases of B waves – mullers and bipolar cells)
5) OCT ( decreases reflectivity of photoreceptors)

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▪ What is the most significant sign in FFA?
Early hypo – later Hyperflurescence.
▪ DD: (white dot syndrome)
1) TB
2) Syphilis
3) Sarcoidosis
4) Histoplasmosis
5) VKH
▪ Complications: - (TRIAD of Vitritis)
1. Cataract
2. CME
3. ERM (epiretinal membrane)
▪ Treatment: -
Acute flares: Steroids
1) Oral Steroids.
2) Intravitreal Triamcinolone implant— ↓ CME and maintained BCVA,
Side effects: -
but patients eventually require cataract surgery and / or anti glaucomatous medications (intraocular
pressure lowering).
Chronic disease: Immunomodulatory Therapy
1) Cyclosporine A (3mg/kg/day to 5mg/kg/day)
2) Methotrexate.

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