May 31, 2019 Conference


Birdshot Chorioretinopathy - Local vs. Systemic Management

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Dr. Lucia Sobrin, Massachussetts Eye and Ear Infirmary (Presenter)

Birdshot chorioretinopathy is a chronic, non-infectious posterior uveitic disease without systemic manifestations.  It is associated very strongly with HLA-A29.  There is a spectrum of disease severity.  In the moderate to severe cases, there can be profound vision loss if it is not appropriately managed. There are multiple treatment options including local treatments, primarily periocular and intraocular corticosteroids, as well as systemic treatments, including traditional immunosuppressant medications and biologics. The indication for local corticosteroid treatment is primarily for the short-term management of vitritis and cystoid macular edema.  Systemic medications are necessary in a majority of patients to avoid ongoing damage from inflammation flares and avoid complications of repeated corticosteroid injections.  For patients who cannot refractory or intolerant to systemic medications, longer acting local corticosteroid implants are sometimes necessary.  Systemic corticosteroid-sparing medications are the mainstay of treatment and can induce long term remission, whereas local corticosteroids should be used for short term control of inflammation.