Choroidal Neovascularization Associated With Birdshot Chorioretinopathy

Area of Science:

• Ophthalmology
• Retinal Diseases
• Immunology

Background:

• Birdshot chorioretinopathy (BCR) can cause vision loss due to choroidal neovascularization (CNV).
• Management strategies for CNV in BCR, especially in the anti-vascular endothelial growth factor (VEGF) era, require further investigation.
• Few studies address the combined therapeutic approach for CNV in BCR.

Purpose of the Study:

• To evaluate the clinical outcomes of combined anti-VEGF therapy and immunosuppressive treatment for CNV in patients with BCR.
• To assess the efficacy of this combination therapy in improving visual acuity and reducing macular edema.

Main Methods:

• Retrospective, interventional case series involving patients with BCR and CNV from two specialized practices.
• Patients received intravitreal anti-VEGF injections combined with initiation or escalation of local or systemic immunosuppression.
• Outcomes included Snellen visual acuity, spectral-domain optical coherence tomography (SD-OCT) macular thickness, and CNV incidence.

Main Results:

• Eleven percent (4/36) of BCR patients developed CNV, necessitating treatment.
• Combination therapy led to a significant improvement in mean visual acuity (20/60 to 20/30, P = .02) and a reduction in mean macular thickness (443 μm to 254 μm, P = .04).
• CNV occurred more frequently in macula-involved BCR compared to macula-spared BCR (0.11 vs. 0 events/patient-year, P = .009).

Conclusions:

• Anti-VEGF therapy is effective in treating CNV associated with birdshot chorioretinopathy.
• A combined approach of anti-VEGF therapy and immunosuppression appears beneficial for managing CNV in BCR patients.
• This combination therapy offers a promising strategy for preserving vision in BCR patients with CNV.