Early and sustained treatment modifies the phenotype of birdshot retinochoroiditis

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The present appraisal of Birdshot retinochoroiditis (BCR) is based on obsolete criteria that only represent advanced disease. Early diagnosis of BC can only be done using indocyanine green angiography (ICGA) showing the typical choroidal involvement. The aim of this study was to investigate long-term follow ups of BRC patients regarding the impact of early treatment on the phenotype of BRC, both on ICGA findings as well as fundus appearance. 13 patients had sufficient data to be included in the study. Out of 13 patients, 8 showed typical birdshot lesions at presentation according to the presently used criteria. A significant proportion of the “no lesions” group did not develop typical birdshot lesions throughout the course. Mean treatment delay was 45.50 ± 33.39 months in the “typical lesions” group and 5.80 ± 2.95 months in the “no lesions” group. Early treatment can avoid the apparition of typical BRC lesions in the same fashion as early and heavy treatment can avoid the development of “sunset glow” fundus in Vogt-Koyanagi-Harada disease (VKH). Early diagnosis relies heavily on ICGA, that together with FA, visual field testing and presence of HLA-A29 antigen allows the diagnosis before typical birdshot lesions can be seen.

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