This 73YO male has a 40-year history of birdshot chorioretinopathy which has been managed most recently with PRN intravitreal Ozurdex and Yutiq. He has also been treated with q4 month Vabysmo injections for macular neovascularization (MNV) OD. He presented with recent decreased vision OD. Vision was counting fingers OD and 20/20 OS.
Color photography shows a large submacular hemorrhage, peripapillary scarring, and multiple creamy birdshot lesions more peripherally. Optos RG imaging 4 months earlier shows bilateral peripapillary scarring and scattered birdshot lesions. OCT scanning shows a hyperreflective type 1 (below the RPE) MNV OD.
Learning Points:
Birdshot chorioretinopathy 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 HLA-A29 association. It usually affects women in their 40s to 60s. Vision loss is usually caused by cystoid macular edema (CME) and retinal atrophy, although MNV, as in our patient, 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.
