This 48YO male presented with these creamy yellow-white choroidal lesions scattered throughout each posterior pole. Vision was 20/25 OU.
Fluorescein angiography shows mild optic nerve leakage, particularly in the left eye, and mild scattered venous staining/leakage in the left eye.
Learning Points:
This disease was appropriately described and named by Drs. Ryan and Maumenee (Am J Ophthlamol 1980;89:31-45) since the lesions look like shotgun birdshot scattered throughout the fundus.
Birdshot is typically chronic and bilateral, with a very high association with HLA-A29. It usually affects women in their 40s to 60s. Vision loss is usually caused by cystoid macular edema (CME) and retinal atrophy, although macular neovascularization can rarely occur. Asymptomatic patients can be observed. CME and symptomatic uveitis can be treated with oral steroids, although many will still require immunomodulatory therapy.
