Choroidal neovascular membrane in Birdshot chorioretinopathy Choroidal neovascular membrane in Birdshot chorioretinopathy. A case report Pablo Plaza, Henar Heras, Patricia Fanlo, Esther Compains Servicio de Oftalmologia. Servicio de Medicina Interna Complejo Hospitalario de Navarra

Case report Birdshot choriorretinopathy since 2006 Visual acuity: RE 20/20 ; LE 20/20 Fundus: Cellophane maculopathy in his right eye; Bilateral white dots Treatment: Corticoids in the outbreaks and Azathioprine Without treatment since 2013

Case report August 2016 Emergencies: Blurry vision and methamorphopsias in his right eye Visual acuity: RE 20/40 LE 20/20 No tyndall, no flare Fundus: Macular scar. OCT: Hyper-reflective material in the subretinal space with intraretinal fluid and increase of the thickness of the temporal perifovea AGF: Hiperfluorescence in early stages with increase of the hyperfluorescence in later stages

Evolution Diagnose: Neovascular membrane in Birdshot chorioretinopathy Treatment: Intravitreous ranibizumab No other treatment was needed in the following reviews Actual visual acuity: 20/20 BE VA: 20/40 VA: 20/20

Discussion Retinal neovascularization may develop in the absence of capillary ischemia in patients with posterior uveitis (1,2) OCT-angiography: ischemia + inflammation may play a role in the pathogenesis of BCR and the development of complications (3) Intravitreal anti-vascular endothelial growth factor injections may be an effective treatment along with or without immunosuppressive therapy (4,5) Inflammation play an important role in this kind of membranes (1,2,3,4) Rouvas et al. reported a complete remission of CNV secondary to multiple evanescent white dot syndrome in a patient after only one ranibizumab intravitreal injection (5)

Take home message Remark the difference between the reactivation of the disease and a vascular complication, such as CNV VEGF was effective and no other treatment was needed Proper studies are needed to establish the therapeutic regime and long term outcomes Bibliography: 1. Emily H. Shao, Victor Menezo, and Simon R.J. Taylor. Birdshot chorioretinopathy. Curr Opin Ophthalmol 2014, 25:488–494 2. Evangelos Minos, Robert J. Barry, Sue Southworth, Annie Folkard, Philip I. Murray, Jay S. Duker,Pearse A. Keane and Alastair K. Denniston. Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment. Minos et al. Orphanet Journal of Rare Diseases (2016) 11:61 3. Nopasak Phasukkijwatana, Nicholas Iafe, David Sarraf. Optical coherente tomography angiography of A29 Birdshot chorioretinopathy complicated by retinal neovascularization. Retinal cases & Brief reports =:1-5, 2016 4. Victor Menezo Simon RJ Taylor. Birdshot uveitis: current and emerging treatment options. Clinical Ophthalmology 2014:8 73–81 5. Rouvas AA, Ladas II, Papakostas TD et al. Intravitreal ranibizumab in a patient with choroidal neovascularization secondary to multiple evanescent white dot syndrome.Eur J Ophthalmol 2007; 17 (6): 996–999