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Klin Monbl Augenheilkd 2012; 229(4): 348-352
DOI: 10.1055/s-0031-1299224
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Indocyanine Green Angiography (ICGA) is Essential for the Early Diagnosis of Birdshot Chorioretinopathy

ICGA ist notwendig für die frühzeitige Diagnose von Birdshot-Chorioretinitis
M. Papadia
1   Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
2   Eye Clinic, Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Italy
,
C. P. Herbort
1   Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
3   University of Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

07 September 2011

05 December 2011

Publication Date:
11 April 2012 (online)

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Abstract

Background: Birdshot chorioretinitis (BC) is a rare disease involving the retina and the choroid independently. The hallmark for BC is the presence of depigmented oval lesion of the choroid, the so called “birdshot lesions”, however in the early phase of disease these lesions are often not visible.

Methods: A retrospective analysis of BC patients that were investigated in Centre for Ophthalmic Specialised Care, Lausanne, Switzerland between 1995 and 2010 was performed.

Patients seen in the initial phase of BC disease devoid of a specific diagnosis when referred were included. Clinical investigations along with fluorescein angiography (FA), indocyanine green angiography (ICGA) and visual field testing (VF) were analysed.

Results: Three out of 7 patients (43 %) seen in the initial phase of the disease devoid of a diagnosis at presentation were analysed. These patients presented with no “birdshot” lesions whatsoever. All three patients were HLA-A29 positive, presented with vitreitis and retinal vasculitis on FA. On ICGA, all 3 patients presented bilateral evenly distributed choroidal hypofluorescent dark dots (HDD) representing choroidal granulomas.

Conclusions: ICGA, by providing occult information on the choroid, is an essential tool for early diagnosis of BC. Because ICGA is still not universally practiced in uveitis centres early disease is often missed, its diagnosis delayed and proper treatment started late.

Zusammenfassung

Hintergrund: Birdshot-Chorioretinitis (BC) ist eine seltene entzündliche Krankheit, die gleichzeitig, aber unabhängig die Netzhaut und Aderhaut betrifft. Depigmentierte ovale Herde in der Aderhaut, die sogenannten “birdshot lesions”, sind das Kennzeichen von BC, jedoch am Anfang der Krankheit sind diese Fundusläsionen nicht zu sehen.

Patienten und Methode: Eine retrospektive Analyse von BC-Patienten, die im Centre for Ophthalmic Specialised Care, Lausanne, Schweiz zwischen 1995 und 2010 untersucht wurden, wurde durchgeführt. Patienten in der anfänglichen Phase von BC wurden in die Studie eingeschlossen. Klinische Untersuchung, Fluoreszenzangiografie (FA), Indocyanine-Grün-Angiografie (ICGA) und Gesichtsfeld-Untersuchungen wurden analysiert.

Ergebnisse: 3 aus 7 Patienten (43 %), die in der anfänglichen Phase von BC untersucht wurden, wurden in die Studie eingeschlossen. Diese Patienten hatten keine Herde in der Aderhaut. Alle 3 Patienten waren HLA-A29-positiv und hatten eine Vitreitis und retinale Vaskulitis, die mit FA dokumentiert wurden. Die ICGA-Untersuchung zeigte bei allen 3 Patienten gleichmäßig verteilte choroidale dunkle Punkte, der ICGA-Ausdruck von stromalen Aderhautgranulomen.

Schlussfolgerung: In der frühen Krankheitsphase gibt ICGA maßgebende Informationen über die Aderhaut und zeigt okkulte Aderhautentzündungen und ist deswegen absolut notwendig für die frühzeitige Diagnose von BC. Da ICGA heutzutage immer noch nicht routinemäßig in Uveitiszentren praktiziert wird, ist die frühzeitige Diagnose von BC oft verschoben mit der Konsequenz, dass viel Zeit verlorengeht, bevor die notwendige Therapie beginnen kann.

Key words

birdshot chorioretinopathy - early diagnosis - ICGA - FA

Schlüsselwörter

Birdshot-Chorioretinitis - frühzeitige Diagnose - ICGA - FA
 

  • References

  • 1 Ryan SJ, Maumenee AE. Birdshot retinochoroidopathy. Am J Ophthalmol 1980; 89: 31-45
    PubMedSearch in Google Scholar
  • 2 Gass JD. Vitiliginous chorioretinitis. Arch Ophthalmol 1981; 99: 1778-1787
    CrossrefPubMedSearch in Google Scholar
  • 3 LeHoang P, Ozdemir N, Benhamou A et al. HLA-A29.2 subtype associated with birdshot retinochoroidopathy. Am J Ophthalmol 1992; 113: 32-35
    PubMedSearch in Google Scholar
  • 4 Fardeau C, Herbort CP, Kullmann N et al. Indocyanine green angiography in birdshot chorioretinopathy. Ophthalmology 1999; 106: 1928-1934
    CrossrefPubMedSearch in Google Scholar
  • 5 Herbort CP. Primary stromal choroiditis. Birdshot chorioretinopathy. In: Gupta A, Gupta V, Herbort CP, Khairallah M, (eds.): Uveitis. Text and Imaging. Jaypee, New Delhi (pub.): 2009: 552-562
    Search in Google Scholar
  • 6 Levinson RD, Brezin A, Rothova A et al. Research criteria for the diagnosis of birdshot chorioretinopathy: results of an international consensus conference. Am J Ophthalmol 2006; 141: 185-187
    CrossrefPubMedSearch in Google Scholar
  • 7 Herbort CP, Probst K, Cimino L et al. Differential inflammatory involvement in retina and choroid in birdshot chorioretinopathy. Klin Monatsbl Augenheilkd 2004; 221: 351-356
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Becker MD, Wertheim MS, Smith JR et al. Long-term follow-up of patients with birdshot retinochoroidopathy treated with systemic immunosuppression. Ocul Immunol Inflamm 2005; 13: 289-293
    CrossrefPubMedSearch in Google Scholar
  • 9 Thorne JE, Jabs DA, Peters GB et al. Birdshot retinochoroidopathy: ocular complications and visual impairment. Am J Ophthalmol 2005; 140: 45-51
    PubMedSearch in Google Scholar
  • 10 Trinh L, Bodaghi B, Fardeau C et al. Clinical features, treatment methods, and evolution of birdshot chorioretinopathy in 5 different families. Am J Ophthalmol 2009; 147: 1042-1047
    CrossrefPubMedSearch in Google Scholar
  • 11 Monnet D, Brézin AP, Holland GN et al. Longitudinal cohort study of patients with birdshot chorioretinopathy. I. Baseline clinical characteristics. Am J Ophthalmol 2006; 141: 135-142
    CrossrefPubMedSearch in Google Scholar
  • 12 de Courten C, Herbort CP. Potential role of computerized visual field testing for the appraisal and follow-up of birdshot chorioretinopathy. Arch Ophthalmol 1998; 116: 1389-1391
    PubMedSearch in Google Scholar
  • 13 Thorne JE, Jabs DA, Kedhar SR et al. Loss of visual field among patients with birdshot chorioretinopathy. Am J Ophthalmol 2008; 145: 23-28
    CrossrefPubMedSearch in Google Scholar
  • 14 Howe LJ, Stanford MR, Graham EM et al. Choroidal abnormalities in birdshot chorioretinopathy: an indocyanine green angiography study. Eye 1997; 11 (04) 554-559
    CrossrefPubMedSearch in Google Scholar
  • 15 Herbort CP. Choroiditis, general considerations and classification. In: Pleyer U, Mondino B, (Eds.) Essentials in Ophthalmology: Uveitis and Immunological Disorders. Berlin, Heidelberg, New York: Springer; 2004: 202-208
    Search in Google Scholar
  • 16 Herbort CP, Guex-Crosier Y, LeHoang P. Schematic interpretation of indocyanine green angiography. Ophthalmology 1994; 2: 169-176
    PubMedSearch in Google Scholar
  • 17 Herbort CP, Mantovani A, Bouchenaki N. Indocyanine green angiography in Vogt-Koyanagi-Harada disease: angiographic signs and utility in patient follow-up. Int Ophthalmol 2007; 27: 173-182
    CrossrefPubMedSearch in Google Scholar
  • 18 Kawaguchi T, Horie S, Bouchenaki N et al. Suboptimal therapy controls clinically apparent disease but not subclinical progression of Vogt-Koyanagi-Harada disease. Int Ophthalmol 2009; 30: 41-50
    PubMedSearch in Google Scholar