2022 Annual Meeting and Alumni Reunion
Category : Clinical Research Candidate : Ashley Li Poster #: C7
High Positive Predictive Value of Fluorescein Angiography Contiguous , Perinerve Retinal Vascular Leakage Pattern for Birdshot Chorioretinopathy
Ashley Li , Atitaya Apivatthakakul , Lucia Sobrin
Purpose : Birdshot chorioretinopathy ( BSCR ) is a posterior uveitis with ovoid yellow-white choroidal lesions . If untreated , patients ’ vision declines , so early diagnosis is critical . While indocyanine green angiography ( ICGA ) is used to identify subtle lesions , ICGA is not always available . Fluorescein angiography ( FA ) is more common and a contiguous , perinerve retinal vascular leakage pattern has been described in BSCR patients . The purpose of this study is to determine the sensitivity and positive predictive value ( PPV ) of a contiguous , perinerve retinal vascular leakage FA pattern for BSCR diagnosis .
Methods : Mass General Brigham patients with a FA Common Procedural Terminology code and mention of BSCR in the free text of notes were identified . BSCR diagnosis required HLA-A29 positivity and typical lesions on fundus photos and / or ICGA hypofluorescent spots . Chart review was performed to confirm BSCR vs . other uveitis / retinal vasculitis diagnosis and symptom duration . The first FA was analyzed for a contiguous , perinerve pattern of leakage by two readers . A perinerve leakage pattern was defined as leakage primarily around the optic nerve and along the larger arcade vessels ( Fig 1 ). We compared the rates of this FA pattern in BSCR vs . other posterior uveitis / retinal vasculitis patients using the chi-square test and determined the sensitivity and PPV of this FA pattern for BSCR diagnosis . All statistical analyses were performed in STATA .
Results : 54 BSCR patients and 42 patients with other posterior uveitis and / or retinal vasculitis were identified ( Table 1 ). A perinerve FA pattern was more common in BSCR patients vs . patients without BSCR ( 53.7 % vs . 4.76 %, p = 3.63 X 10-7 ). The sensitivity and specificity of the FA pattern were 53.7 % and 95.2 %, respectively . The PPV was 93.5 %. BSCR patients with an FA perinerve pattern had a shorter time from symptom onset to FA vs . BSCR patients without the pattern ( 217 vs . 1510 days , p =. 0015 , t-test ).
Conclusions : An FA contiguous , perinerve retinal vascular leakage pattern is a useful tool to identify potential BSCR for further imaging and serological testing . This pattern is more common when the interval between symptom onset and FA is shorter .