Early diagnosis and treatment changes disease phenotype in birdshot retinochoroiditis

Abstract

AbstractBackground and Aim: The diagnosis of birdshot retinochoroiditis (BRC) relies mainly on the presence of oval‐shaped "birdshot lesions" (BL) part of the currently used inappropriate diagnostic criteria that do not use diagnostic tools for choroidal disease such as ICG angiography (ICGA) and do not allow to make an early diagnosis. It is now well‐known that when BL become apparent, the disease has already been evolving since months or years. Patients and methods: Using appropriate diagnostic criteria, including vitritis and retinal vasculitis in at least one eye, presence of ICGA detected choroiditis in both eyes and the presence of the HLA‐A29 antigen, we compared a group of patients treated early (< 10 months of symptoms) with a group of patients treated after more than 10 months of symptoms. Mean follow‐up was 10 years in bothe groups. Results: Patients treated early almost never developed the characteristic BL, whereas patients treated late all presented BL at start of therapy that almost never disappeared after treatment. Conclusion: Early diagnosis and treatment modifies the phenotype of BRC by preventing the apparition of BL clearly indicating that the presently used diagnostic criteria are completely inappropriate.