Peripapillary Halo in Inflammatory Papillitis of Birdshot Chorioretinopathy

Mohamed M Khodeiry; Xiangxiang Liu; Mohamed S Sayed; Raquel Goldhardt; Giovanni Gregori; Thomas A Albini; Richard K Lee

doi:10.2147/OPTH.S307589

Peripapillary Halo in Inflammatory Papillitis of Birdshot Chorioretinopathy

Clin Ophthalmol. 2021 Jun 3:15:2327-2333. doi: 10.2147/OPTH.S307589. eCollection 2021.

Authors

Mohamed M Khodeiry^{1

2}, Xiangxiang Liu^{1

3}, Mohamed S Sayed¹, Raquel Goldhardt¹, Giovanni Gregori¹, Thomas A Albini¹, Richard K Lee¹

Affiliations

¹ Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
² Research Institute of Ophthalmology, Department of Ophthalmology, Giza, 12557, Egypt.
³ Beijing Eye Institute, Beijing Tongren Eye Center, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.

Abstract

Purpose: Peripapillary halos (PPH) are peripapillary changes observed surrounding the optic nerve head in normal eyes and eyes with different disorders. Recognizing the microstructure and mechanism of development of these halos will help clinicians understand the different associated retinal and optic nerve head pathologies. We describe the in vivo histological characteristics of PPH in birdshot chorioretinopathy (BSCR).

Patients and methods: This was a prospective observational case-series in a single tertiary referral center. Six eyes of three patients with PPH associated with BSCR were determined through clinical examination, fundus photography, and fundus autofluorescence (FAF). Patients underwent swept-source optical coherence tomography (SS-OCT) imaging of the optic nerve head and peripapillary region.

Results: In SS-OCT B-scans across the area of PPH, we observed thinning and interruption of retinal pigment epithelium (RPE)-Bruch's membrane complex. These halos are a circumferential form of alpha zone RPE-associated crescentic peripapillary atrophy (PPA), unlike the PPH observed with myopia and normal aging.

Conclusion: PPH in BSCR patients may be a sign of prior inflammatory optic neuropathy.

Keywords: birdshot chorioretinitis; optic nerve head; optical coherence tomography; peripapillary atrophy; peripapillary halo.

Grants and funding

T.A.A: Support- Klorfine Foundation. R.K.L: Support - Walter G. Ross Foundation. The Bascom Palmer Eye Institute is supported by NIH Center Core Grant P30EY014801 and an unrestricted Grant from Research to Prevent Blindness This work was partly supported by the Gutierrez Family Research Fund. The sponsors or the funding organizations have no role in the design or conduct of this research.