Recommendations for the management of Birdshot retinochoroiditis

González-López, J.J.; Ciancas, E.; Revenga, M.

doi:10.1016/j.oftale.2016.09.006

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Pueden observarse las lesiones hipopigmentadas clásicas, sobre todo en el ojo izquierdo, más sintomático. C y D) Angiografía con fluoresceína en el que puede observarse la vasculitis primaria bilateral asimétrica, con mayor afectación del ojo izquierdo. E) Angiografía con verde de indocianina del ojo derecho. A los 7min pueden observarse las clásicas lesiones coroideas hipopigmentadas, que no se aprecian en la simple exploración clínica en ese ojo. F) Angiografía con verde de indocianina del ojo izquierdo. En tiempos más tardíos (40min) se siguen observando las lesiones hipopigmentadas a nivel coroideo." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. González-López, E. Ciancas, M. Revenga" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "González-López" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Ciancas" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Revenga" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579416301293" "doi" => "10.1016/j.oftale.2016.09.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416301293?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116300247?idApp=UINPBA00004N" "url" => "/03656691/0000009200000004/v1_201703230047/S0365669116300247/v1_201703230047/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173579417300373" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.12.003" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "1126" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Soc Esp Oftalmol. 2017;92:194-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 71 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 50 "PDF" => 11 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Author's reply" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "194" "paginaFinal" => "195" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta de los autores" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. 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González-López, E. Ciancas, M. Revenga" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.J." "apellidos" => "González-López" "email" => array:1 [ 0 => "juliojose.gonzalez@live.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Ciancas" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Revenga" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones en el manejo de la retinocoroiditis de Birdshot" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3029 "Ancho" => 2637 "Tamanyo" => 489406 ] ] "descripcion" => array:1 [ "en" => "(A and B) full field electro-retinograph of 2 males aged 50 and 67 respectively, both HLA-A29 positive, with a diagnostic of Birdshot retinochoroiditis. The images show a bilateral delay in the 30Hz photopic flicker." ] ] ] "textoCompleto" => "We have read with great interest the article by Rivera de Zea et al., titled “Dexamethasone intravitreal implant for treatment of persistent macular edema in Birdshot retinochoroidopathy”, published in the March 2016 issue of this journal. We would like to thank the authors for their interesting contribution and summarize some data about Birdshot retinochoroidopathy (BRC) which are important for adequately managing BRC patients.BRC is a granulomatous panuveitis which predominantly compromises the choroidal stroma, as in the Vogt–Koyanagi–Harada (VKH) syndrome and sympathetic ophthalmia (SO). In contrast with both entities, BRC also comprises primary retinitis which is not a consequence of choroiditis. For this reason, even though aggressive systemic treatment in the acute phase resolves the retinal and choroidal inflammation in VKH and SO, retinitis is generally more resistant in BRC,<a class="elsevierStyleCrossRef" href="#bib0020">1</a> as observed by Rivera de Zea et al.The histology of BRC was described by Gaudio et al. in 2002, who observed an infiltrate comprised by epitheloid sentences surrounding choroidal melanocytes.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> It is believed that these infiltrates correspond to hypo-fluorescent lesions observed in indocyanine green angiography (ICGA) of these patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). At present, the presence of said hypo-florescent lesions in ICGA are considered to be an essential criterion for clinical BRC diagnostic.<a class="elsevierStyleCrossRef" href="#bib0020">1</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>It is important to carry out a complete study on said patients both at diagnostic and follow-up. Retinal signs in the acute or exudative phase, the presence of vasculitis and vitritis, are easily observable in clinic. However, the inflammatory choroidal activity of the chronic phase of the disease goes frequently unnoticed in clinical examinations. Frequently, patients experience symptoms and visual worsening even in the absence of clinical inflammation signs. For this reason, it is recommended to include serial ICGA studies, automated perimetry and full field electro-retinography in the follow-up of these patients, in addition to clinic examinations. It is frequent to observe delays in 30Hz flicker latency in photopic conditions in patients with untreated BRC (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The disappearance of hypo-fluorescent lesions in ICGA as well as the normalization of the 30Hz flicker in photopic conditions has been associated with positive response when diminishing immunosuppressant treatment in patients with BRC.<a class="elsevierStyleCrossRef" href="#bib0030">3</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>FundingThe authors state that they have not received funding for this article.Conflict of interestsJJGL has received study grants from Allergan, Santen and Thèa, and has been a consultant for Bayer." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González-López JJ, Ciancas E, Revenga M. Recomendaciones en el manejo de la retinocoroiditis de Birdshot. Arch Soc Esp Oftalmol. 2017;92:195–197." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1969 "Ancho" => 1653 "Tamanyo" => 478597 ] ] "descripcion" => array:1 [ "en" => "(A and B) color retinographs taken at the presentation of a female, 39, with a diagnostic of Birdshot retinochoroiditis, carrying HLA-A29. The images show the typical hypo-pigmented lesions, mainly in the left eye which is more symptomatic. (C and D) fluorescein angiography showing asymmetric bilateral primary vasculitis with greater involvement in the left eye. (E) Right eye indocyanine green angiography, showing at 7min the typical hypo-pigmented choroidal lesions which cannot be seen in simple clinical examination. (F) Left eye indocyanine green angiograph, showing in late times (40min) the hypo-pigmented lesions at the choroidal level." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3029 "Ancho" => 2637 "Tamanyo" => 489406 ] ] "descripcion" => array:1 [ "en" => "(A and B) full field electro-retinograph of 2 males aged 50 and 67 respectively, both HLA-A29 positive, with a diagnostic of Birdshot retinochoroiditis. The images show a bilateral delay in the 30Hz photopic flicker." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New concepts in the appraisal and management of birdshot retinochoroiditis, a global perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Papadia" 1 => "C.P. Herbort" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10792-015-0046-x" "Revista" => array:6 [ "tituloSerie" => "Int Ophthalmol" "fecha" => "2015" "volumen" => "35" "paginaInicial" => "287" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25680419" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathology of birdshot retinochoroidopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.A. Gaudio" 1 => "D.B. Kaye" 2 => "J.B. Crawford" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2002" "volumen" => "86" "paginaInicial" => "1439" "paginaFinal" => "1441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12446382" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pointwise linear regression analysis of serial Humphrey visual fields and a correlation with electroretinography in birdshot chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Arya" 1 => "M. Westcott" 2 => "A.G. Robson" 3 => "G.E. Holder" 4 => "C. Pavesio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjophthalmol-2014-306003" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2015" "volumen" => "99" "paginaInicial" => "973" "paginaFinal" => "978" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25637598" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000004/v1_201703230033/S2173579416301293/v1_201703230033/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000004/v1_201703230033/S2173579416301293/v1_201703230033/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416301293?idApp=UINPBA00004N"]

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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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