Birdshot chorioretinopathy is strongly associated with HLA-A29 (>95% of cases). The characteristic fundus finding that distinguishes it from multifocal choroiditis is:

• A Punched-out atrophic scars at the RPE level with overlying yellow-white lesions
• B Large geographic areas of choroidal atrophy involving the posterior pole
• C Discrete white lesions in the vitreous base causing tractional retinal detachment
• D Cream-coloured, elongated oval spots radiating from the disc in a nasal-to-temporal pattern without pigmentation or excavation ✓

Explanation

Birdshot chorioretinopathy presents with characteristic cream-coloured, oval 'birdshot' lesions distributed from the optic disc in a spoke-like or nasal-to-temporal pattern. Critically, these lesions are at the RPE-choroidal level and lack the 'punched-out' appearance with pigmented borders seen in multifocal choroiditis. Vitritis, cystoid macular oedema (CME), and vasculitis cause progressive visual loss. ERG is characteristically abnormal (reduced b-wave amplitude, reduced oscillatory potentials) even before structural damage. ICGA reveals more numerous hypofluorescent spots than visible on FFA. Treatment requires systemic immunosuppression (mycophenolate, cyclosporine) with or without systemic steroids.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.