Long-Term Outcomes of Birdshot Chorioretinopathy Treated with Corticosteroids: A Case Reports

HIGHLIGHTS: What is known? Corticosteroids alone are considered ineffective in treating and preventing relapses in birdshot chorioretinopathy (BSCR). Although many studies have been conducted in recent years, highlighting the effectiveness of immunosuppressive drugs, there is currently no consensus on the optimal treatment modalities and duration of treatment for BSCR. We have previously shown in a series of 14 patients that intravenous corticosteroid therapy followed by prednisone treatment resulted in control of ocular inflammation in 71% of patients. What is new? The prolonged corticosteroid therapy treatment strategy resulted in inflammation control in almost half of our patients with BSCR. This control was maintained with low doses of cortisone, usually less than 5 mg daily. Initial loading doses did not appear to significantly reduce the time needed to reach inflammation control or the number of relapses, nor did they improve the final visual prognosis. However, we could not conclude that methylprednisolone may not be helpful since the two groups were different at baseline, with more patients with macular edema treated with initial intravenous corticosteroids. ABSTRACT: Purpose: To report the progression of patients diagnosed with birdshot chorioretinopathy (BSCR) initially treated with corticosteroids. Methods: We included 39 BSCR patients that were followed for ≥1 year. We analyzed their progression under treatment after 1, 3, 6 months, 1 year, and at the end of follow-up. In order to determine the efficiency of initial loading doses, patients were classified into two groups according to their initial treatment: methylprednisolone followed by prednisone (n = 28) and prednisone alone (n = 11). Results: At the end of follow-up, 31/39 (79.5%) patients had reached inflammation control. Thirteen out of 28 (46.4%) and 6/11 (54.5%) patients were treated exclusively with corticosteroids, and 18/19 (94.7%) of them had reached inflammation control at the end of follow-up; their mean (range) corticosteroid dose was 3.5 (0–10) mg/day. Conclusions: We found that the prolonged corticosteroid therapy treatment strategy resulted in inflammation control in half of BSCR patients. This control was maintained with low doses of cortisone, usually <5 mg/day.