top of page

Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

OCTcases (logo1).png

Uveitis

Case 19

Patient Presentation: A 47-year-old European woman presented with decreased vision and floaters OU. She denied pain, red eye, photophobia, or recent trauma. She had no past medical history or ocular history. There was no family history of eye disease. Review of systems was unremarkable.

Visual acuity was 20/40 OD and 20/50 OS. IOP was normal and there was no RAPD. Slit lamp examination was unremarkable.

Dilated fundus examination revealed 1+ vitreous cells OU and the findings on the fundus photographs below:

Question 1: Describe the main findings on fundus exam.

Click Here For Answer

OCT macula images were taken and are shown below:

Question 2: Describe the OCT macula images.

Click Here For Answer

Question 3: Based on the history, fundus findings, and OCT findings, what is the most likely diagnosis?

A. Multiple Evanescent White Dot Syndrome (MEWDS)

B. Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE)

C. Birdshot Chorioretinopathy

D. Multifocal choroiditis and panuveitis (MCP)

Question 4: Which of the following haplotypes is most strongly associated with birdshot chorioretinitis?

IVFA imaging was conducted and is shown below (early OD, late OD, late OS):

Question 5: Which of the following descriptions of the IVFA photos is most accurate?

A. Hyperfluorescence in the areas corresponding to the lesions and peripapillary leakage, with vasculitis in zone 1 only.

B. Late hyperfluorescence in the areas corresponding to the lesions and peripapillary leakage, with vasculitis in zones 1-3

C. Hyperfluorescence of the macula and in the areas corresponding to the lesions and peripapillary leakage, with vasculitis in zones 1-3

D. Early hypofluorescence/late hyperfluorescence of the macula, with vasculitis in zones 1-3

References:

Teussink MM, Huis In Het Veld PI, de Vries LA, Hoyng CB, Klevering BJ, Theelen T. Multimodal imaging of the disease progression of birdshot chorioretinopathy. Acta Ophthalmol. 2016;94(8):815-823. doi:10.1111/aos.13114
Kiss S, Anzaar F, Stephen Foster C. Birdshot retinochoroidopathy. Int Ophthalmol Clin. 2006;46(2):39-55. doi:10.1097/00004397-200604620-00006
Bousquet E, Duraffour P, Debillon L, Somisetty S, Monnet D, Brézin AP. Birdshot Chorioretinopathy: A Review. J Clin Med. 2022;11(16):4772. Published 2022 Aug 16. doi:10.3390/jcm11164772

Learning Objectives:

Recognize the funduscopic appearance and OCT findings of birdshot chorioretinopathy.
Understand the HLA haplotype associated with birdshot chorioretinopathy.
Visualize the retinal inflammation and vessel vasculitis in birdshot chorioretinopathy.

bottom of page