Birdshot Chorioretinopathy with Cystoid Macular Oedema

Abstract: We report the case of a 48-year-old Caucasian male who presented with progressive bilateral visual decline over more than three months. He was diagnosed with birdshot chorioretinopathy (BSCR) according to the Standardization of Uveitis Nomenclature (SUN) criteria, based on characteristic fundus findings and HLA-A29 positivity. Laboratory investigations, including angiotensin-converting enzyme (ACE) and soluble IL-2 receptor levels, were within normal limits and infectious serologies were negative. Thoracic imaging by computed tomography showed no signs suggestive of sarcoidosis or infection, and pulmonary function testing was normal. Systemic corticosteroids combined with methotrexate improved vitritis but left cystoid macular edema (CME) largely unchanged, especially in the right eye. Therapy was therefore switched to mycophenolate mofetil and adalimumab, which produced a marked reduction of CME, although some cystic changes persisted. This case highlights the therapeutic challenges in the real-world management of BSCR complicated by persistent CME. Even with reduction of intraocular inflammation, CME may remain resistant to systemic corticosteroids alone, particularly in patients presenting late in the disease course. Early diagnosis, exclusion of systemic mimics, and a flexible, imaging-guided approach to treatment are essential for optimising visual prognosis.