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Birdshot Chorioretinopathy with Double-Layer Sign and Choroidal Neovascularization: A Single-Centre Analysis
Alessandro Marchese1,2, Timothy M Janetos1, Anjum F Koreishi1
1Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Introduction:
Birdshot chorioretinopathy (BSCR) is a chronic posterior uveitis. In some cases, hyperreflective material between the retinal pigment epithelium (RPE) and Bruch's membrane is noted on optical coherence tomography (OCT), the so-called double-layer sign. This study describes the clinical features associated with the double-layer sign on OCT in BSCR.
Methods:
In retrospective, observational study of patients with BSCR, charts and OCT images of consecutive patients were reviewed and the presence of the double-layer sign on OCT was noted. Clinical features associated with the double-layer sign were analyzed.
Results:
Forty-nine patients with HLA-A29+ BSCR were retrospectively reviewed and 15 eyes (15%) of 9 patients (18%) demonstrated the presence of the double-layer sign on OCT. The presence of CNV corresponding to the double-layer sign on OCT was confirmed in eyes that had additional imaging (11 out of 15 eyes; 73%). Intra- or subretinal exudation was present at some point during follow-up in 5/15 eyes (33%), and 3/15 eyes received treatment with intravitreal bevacizumab (20%).
Conclusions:
Birdshot chorioretinopathy can develop a double-layer sign on OCT often harboring a non-exudative or minimally active choroidal neovascularization. This sign in patients with BSCR might indicate chronic inflammation involving the posterior pole.
