Inflammatory chorioretinopathies

Question 1

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Answer 1

• Birdshot: Age 30-70 (older); F>M, Bilateral, 80-98% are HLA A29 positive. Insiduous onset, chronic, recurrent. Prognosis guarded without treatment. Therapy: systemic/local steroids; IMT.

Question 2

Birdshot Symptoms

Answer 2

• Blurred vision, floaters, photopsias, disturbed color / night vision.

Question 3

Birdshot Exam

Answer 3

• vitritis, ovoid creamy white-yellow post-equatorial lesions

Question 4

Birdshot Complications

Answer 4

vasculitis, disc edema, CME, CNV (6%)

Question 5

Birdshot FA

Answer 5

early hypofluorescence, late stain, leakage from disk, CNVM

Question 6

Birdshot ICG

Answer 6

hypofluorescent lesions more numerous than on exam

Question 7

Birdshot FAF

Answer 7

hypoautofluourescent lesions more numerous than clinically apparent; placoid macular hypoautofluoresence with central vision loss

Question 8

Birdshot OCT

Answer 8

ME, loss of IS/OS, suprachoroidal fluid

Question 9

Birdshot ERG

Answer 9

abnormal rod/cone response

Question 10

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Answer 10

• APMPPE: Age 20-50 (young). M=F. Bilateral. Viral prodrome, cerebrovasculitis, CSF abnormalities. Course is acute and self-limited. Visual prognosis is good. Therapy is observation; steroids if CNS involvement.

Question 11

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Answer 11

• Serpiginous Chorioretinitis: Age 20-60 (young-middle). M=F. Bilateral but asymmetric. Systemic association HLA B7. Rule out TB. Onset/course is variable and self-limited. Visual prognosis is guarded. Therapy is systemic/ local steroids and IMT. Anti-VEGF w/wo laser for CNVM.

Question 12

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Answer 12

• Age 9-69 (usually more young). F>M (3:1). Bilateral. Onset/course is insidious, . chronic/recurrent. Visual prognosis: guarded. Treatment: steroids, IMT. Anti-VEGF, +/- laser for CNVM.

Question 13

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Answer 13

PIC: age 18-40 (young). F (90%); bilateral. Onset/course is acute/self-limited. Prognosis is good if no CNVM. Treatment is systemic/local steroids, IMT, antivegf +/- laser

Question 14

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Answer 14

SFU: subretinal fibrosis and uveitis syndrome. Age 14-34 (Young). F>M (>95%). Asymmetric. Insidious, chronic, recurrent. Prognosis is guarded. Treatment is steroids for CME if present

Question 15

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Answer 15

• MEWDS: young (10-47); F (3:1), unilateral. Assc’n with viral prodrome in 50%. Course is acute, self limited. Prognosis is excellent. No treatment, just observation.

Question 16

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Answer 16

• ARPE: young (16-40). M=F. Unilateral (75%). No associated systemic issues. Acute self-limited. Prognosis is excellent. No treatment.

Question 17

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Answer 17

AZOOR: young. (13-63). F (3:1). Unilateral 24% of the time, bilateral 76% of the time. Associated with systemic autoimmune disease 28% of the time. Insiduous, chronic, recurrent (31% of the time). Prognosis is guarded. Treatment is steroids, IMT +/- antivirals

Question 19

APMPPE symptoms

Answer 19

blurred vision, scotomata, photopsias

Question 20

APMPPE exam

Answer 20

multifocal flat gray-white lesions 1-2 DD, RPE with evolving pigment

Question 21

APMPPE complications

Answer 21

disc edema, pigmentary changes

Question 22

APMPPE FA

Answer 22

acute lesions, early blockage, late staining, late window defects

Question 23

APMPPE ICG:

Answer 23

hypofluorescent spots

Question 24

APMPPE FAF

Answer 24

• hyperfluourscent areas corresponding to FA blockage and hypofluorescent areas corresponding to staining.

Question 25

APMPPE OCT

Answer 25

outer retinal hyper-reflectivity with intra retinal and subretinal fluid

Question 26

Serpiginous symptoms

Answer 26

blurred vision, scotomata

Question 27

Serpiginous exam

Answer 27

* geographic yellow-gray macular chorioretinal lesions with centrifugal extension. Activity is at leading edge with atrophy in its wake.

Question 28

Serpiginous complications

Answer 28

CNVM (25%), RPE mottling, scarring, loss of choriocapillaris

Question 29

Serpiginous FA:

Answer 29

early hypofluorescence, late staining/ leak of active border/ CNVM

Question 30

Serpiginous ICG

Answer 30

early hypofluorescence, late stain, more widespread than on exam

Question 31

Serpiginous FAF

Answer 31

hyperfluorescent active lesions, hypofluorescent regressed lesions

Question 32

Serpiginous OCT

Answer 32

* outer retinal hyperreflectivity in active lesions, RPE atrophy in regressed lesions

Question 33

MCP symptoms

Answer 33

blurred vision, floaters, photopsias, metamorphopsias

Question 34

MCP exam

Answer 34

* myopia, anterior uveítis (50%), vitritis (100%), active white-yellow lesions evolving to punched out scars.

Question 35

MCP complications

Answer 35

* disc edema, peripapillary pigment changes, CME (14-44%), CNVM (33%).

Question 36

MCP FA:

Answer 36

early block, late stain/leakage

Question 37

MCP ICG

Answer 37

* many hypofluorescent lesions, confluence more around the nerve, more than on exam

Question 38

MCP OCT:

Answer 38

sub-RPE deposits with overlying retinal distruption

Question 39

MCP ERG

Answer 39

abnormal, extinguished responses

Question 40

PIC symptoms:

Answer 40

paracentral; scotoma, photopsias, metamorphopsias

Question 41

PIC Exam

Answer 41

myopia; vitritis is ABSENT; white-yellow chorioretinal lesions

Question 42

PIC Complications

Answer 42

CNVM (17-40%), serous detachment over confluent lesions

Question 43

PIC FA:

Answer 43

early block or HYPERfluorescence, variable late stain/leakage of acute lesions

Question 44

PIC ICG:

Answer 44

hypofluorescent peripapillary/posterior pole lesions.

Question 45

PIC FAF/OCT

Answer 45

similar to MCP. sub-RPE deposits with overlying retinal distruption

Question 46

SFU symptoms

Answer 46

* blurred vision, decreased vision

Question 47

SFU Exam:

Answer 47

moderate vitritis, yellow-white lesions in posterior pole to mid-periphery. RPE hypertrophy, atrophy, large stellate zones of subretinal fibrosis.

Question 48

SFU complications

Answer 48

* retinal detachments, CME, CNVM

Question 49

SFU FA

Answer 49

* alternating hyper/hypo fluorescent areas.

Question 50

SFU OCT

Answer 50

variable edema, SR fluid, subretinal fibrosis

Question 51

MEWDS symptoms

Answer 51

blurred/decreased vision, scotoma, photopsias

Question 52

MEWDS exam

Answer 52

myopia, mild anterior uveitis, vitritis, small white-orange evanescent perifoveal dots.outer retina/RPE macular granularity.

Question 53

MEWDS complications:

Answer 53

disc edema, venous sheathing

Question 54

MEWDS FA

Answer 54

* early punctate hyperfluorescence, wreathlike configuration. Late staining of lesions/ optic nerve.

Question 55

MEWDS ICG

Answer 55

* multiple hypofluorescent spots, more numerous than on exam.

Question 56

MEWDS FAF:

Answer 56

* hyperfluorescent spots.

Question 57

MEWDS OCT:

Answer 57

abnormal IS/OS

Question 58

ARPE exam

Answer 58

small hyperpigmented lesions with yellow halos, unassociated vitritis

Question 59

ARPE FAF

Answer 59

early hyperfluorescence with surrounding halo of hypofluorescence.

Question 60

Azoor symptoms

Answer 60

photopsias, scotoma

Question 61

Azoor exam:

Answer 61

* initially subtle RPE changes, late pigment migration, focal perifoveal sheathing.

Question 62

Azoor complications

Answer 62

RPE mottling, occasional CME

Question 63

Azoor OCT

Answer 63

loss of IS/OS.

Question 64

* Inflammatory chorioretinopathies helpful hints (5):

Answer 64

* (1) all bilateral except SFU/serpiginous (asymmetric), MEWDS, (unilateral), ARPE (unilateral 75%), Azoor (unilateral 24% of the time, bilateral 76% of the time). * (2) all can be seen younger except birdshot tends to be older * (3) F\>M except: APMPPE, serpiginous, ARPE (M=F). PIC is 90% F. SFU is \>95% F. * (4) PIC = NO vitritis. MCP = always vitritis * (5) Associated CNVM: serpiginous (25%), MCP (33%), PIC (17-40%), SFU, Birdshot (6%)