Birdshot Chorioretinopathy

Birdshot chorioretinopathy is a well-known, yet poorly understood, form of posterior uveitis, characterized by multiple, distinctive, hypopigmented choroidal lesions, and strongly associated with human leukocyte antigen (HLA)-A29. We reviewed all English language publications regarding birdshot chorioretinopathy and performed analyses of combined patient data taken from these articles. The mean age at presentation was 53 years, with a slight female predominance (54.1%). At least 95.7% of reported patients have been HLA-A29-positive. Blurring of vision and floaters are the most prevalent presenting complaints, even in patients with visual acuity of 20/20 or better in both eyes. Birdshot chorioretinopathy is a slowly progressive disease with profound dysfunction of vision that may not be reflected in Snellen visual acuity. Two or more lines of Snellen visual acuity were lost in approximately 20% of eyes over a median follow-up of 3.5 years; macular edema was the most common cause of reduced visual acuity. Overall, patients had a slow decline in visual acuity, despite the fact that nearly all were treated with anti-inflammatory therapies. Final visual acuity in the better eye was 20/40 or better in 75.1% of patients and 20/200 or worse in 9.8% of patients. Oral corticosteroids and cyclosporine were the most commonly used medications. Using a regression model, patients in the literature that have been treated with cyclosporine alone had better final visual acuity than patients treated with oral corticosteroids alone. Further study is needed to determine the optimal methods for treating and monitoring patients with birdshot chorioretinopathy

Intraocular Inflammation Associated with Ocular Toxoplasmosis: Relationships at Initial Examination

PURPOSE: To describe characteristics of intraocular inflammation in eyes with active ocular toxoplasmosis and to identify relationships between signs of inflammation, complications (including elevated intraocular pressure [IOP]), other disease features, and host characteristics.DESIGN: Multicenter, retrospective, cross-sectional study.METHODS: We reviewed the medical records of 210 patients with toxoplasmic retinochoroiditis at seven in ternational sites (North America, South America, and Europe) for information from the first examination at each site during which patients had active retinal lesions. Signs of inflammation included anterior chamber (AC) cells and flare and vitreous humor cells and haze. Retinal lesion characteristics included size (1 DA) and presence or absence of macular involvement.RESULTS: AC cells and flare were related to vitreous inflammatory reactions (P <= .041). One or more signs of increased inflammation were related to the following factors: older patient age, larger retinal lesions, and extramacular location. in 30% of involved eyes, there was evidence of elevated IOP (despite use of glaucoma medications by some patients); other complications were uncommon. IOP of more than 21 mm Hg was associated with both increased AC cells and elevated flare (both P <= .001) and with macular involvement (P = .009). Inflammation seemed to be more severe among patients in Brazil than among those at other sites.CONCLUSIONS: There is substantial variation between patients in the severity of intraocular inflammation associated with ocular toxoplasmosis, attributable to multiple host and disease-related factors. Results suggest that disease characteristics also vary in different areas of the world. Elevated IOP at initial examination reflects the severity of inflammation. (Am J Ophthalmol 2008;146:856-865. (C) 2008 by Elsevier Inc. All rights reserved.)RESEARCH TO PREVENT BLINDNESS INC, NEW YORK, NEW YORKJULES Stein Eye InstituteSkirball Foundation, New York, New YorkHeed Foundation, Chicago, IllinoisEmily Plumb Estate and TrustConsultores Oftalmol, RA-1018 Buenos Aires, DF, ArgentinaUniv Calif Los Angeles, David Geffen Sch Med, Ocular Inflammatory Dis Ctr, Jules Stein Eye Inst, Los Angeles, CA 90095 USAUniv Calif Los Angeles, David Geffen Sch Med, Dept Ophthalmol, Los Angeles, CA 90095 USAKings Coll London, London WC2R 2LS, EnglandUniv Med Ctr, FC Donders Inst Ophthalmol, Utrecht, NetherlandsUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniv Calif San Francisco, Francis I Proctor Fdn, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Ophthalmol, San Francisco, CA 94143 USAMed Univ Vienna, Univ Klin Augenheikunde & Optometrie, Vienna, AustriaMalayan Eye Inst, Yerevan, ArmeniaUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc