346
Birdshot chorioretinopathy (BCR) is a rare posterior
uveitis characterized by bilateral multiple cream-
colored choroidal lesions, moderate vitritis, and
strong association with the allele HLA-A29.
1,2
BCR
is a chronically progressive disease and patients
often complain of decreased vision and other visual
disturbances.
3,4
Legal blindness can be present in
20% of affected patients after 10 years of follow-up
5
Floaters, abnormal color vision, and nyctalopia are
also common despite preserved visual acuity.
6
Corticosteroids have historically been the frst line
of treatment in BCR. In addition to oral treatment,
periocular or intravitreal injections of triamcinolone
acetonide have been used. As a high dose of corti-
costeroids is commonly necessary to control the dis-
ease, immunosuppressive agents have been largely
used.
6,7
The effect of treatment may be linked to the
pattern of the disease. Birdshot chorioretinopathy
(BCR) can be associated with vitreoretinal complica-
tions, including macular edema, persistent vitreous
opacities, vitreous hemorrhage, epiretinal mem-
brane, and choroidal neovascular membranes.
2,3,8
All of these can cause severe visual loss and may
require vitreo-retinal surgery. The aim of this study
is to evaluate the outcomes of pars plana vitrectomy
(PPV) in 16 eyes with vitreo-retinal complications
of BCR.
PATIENTS AND METHODS
The authors performed a retrospective review of the
clinical charts of patients with BCR who underwent
PPV indicated as treatment of vitreo-retinal complica-
tions refractory to medical treatment. Subjects were
9 consecutive patients selected from a cohort of 54
patients (16.6%) with BCR followed at the Department
of Ophthalmology, Hospital Clínic de Barcelona,
Spain.
The diagnosis of BCR was established according
to the research criteria of an international consensus
conference of experts in BCR.
9
Although HLA-A29
positivity is not required for diagnosis, all our patients
had tested positive. As stated in these criteria, the
presence of other entities mimicking BCR was used
as an exclusion criterion.
Evaluation with best-corrected visual acu-
ity (BCVA), fundus photography, Cirrus High
Ocular Immunology & Infammation, 19(5), 346–352, 2011
Copyright © 2011 Informa Healthcare USA, Inc.
ISSN: 0927-3948 print/ 1744-5078 online
DOI: 10.3109/09273948.2011.590265
Received 26 October 2010; revised 15 May 2011; accepted 18 May 2011
Correspondence: Víctor Llorenç, C/Girona, 147, 2°-2ª, 08037 Barcelona, Spain. E-mail: llorens.victor@gmail.com
ORIGINAL ARTICLE
Pars Plana Vitrectomy for Vitreo-Retinal Complications of
Birdshot Chorioretinopathy
Víctor Llorenç, Johannes Keller, Laura Pelegrín, and Alfredo Adán
Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Barcelona, Spain
ABSTRACT
Purpose: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) in the treatment
of vitreoretinal complications of birdshot chorioretinopathy (BCR).
Methods: The clinical records of 9 consecutive patients (16 eyes) with vitreo retinal complications in BCR refrac-
tory to medical therapy who underwent pars plana vitrectomy were reviewed.
Results: Indications for PPV were macular edema in 9 eyes (56.2%), and persistent vitreous opacities in 7
(43.8%). At a mean postoperative follow-up of 44.1 months, best-corrected visual acuity improved ≥2 Snellen
lines in 9 eyes (56.2%), remained stable in 6 (37.5%) and worsened in 1 eye (11.1%). Systemic medication was
signifcatively reduced after surgery (p = .020) and macular thickness on optical coherence tomography exams
decreased signifcatively in eyes with macular edema (p = .0039).
Conclusions: In this small series of eyes with limited follow-up PPV seems to be a safe and effective for treat-
ment of vitreoretinal complications in patients with BCR.
Keywords: birdshot chorioretinopathy, macular edema, pars plana vitrectomy, surgery, treatment, uveitis