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. 2021 Aug:228:65-71.
doi: 10.1016/j.ajo.2021.03.059. Epub 2021 Apr 15.

Classification Criteria for Birdshot Chorioretinitis

Standardization of Uveitis Nomenclature (SUN) Working Group
Collaborators

Classification Criteria for Birdshot Chorioretinitis

Standardization of Uveitis Nomenclature (SUN) Working Group. Am J Ophthalmol. 2021 Aug.

Abstract

Purpose: To determine classification criteria for birdshot chorioretinitis.

Design: Machine learning of cases with birdshot chorioretinitis and 8 other posterior uveitides.

Methods: Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set.

Results: One thousand sixty-eight cases of posterior uveitides, including 207 cases of birdshot chorioretinitis, were evaluated by machine learning. Key criteria for birdshot chorioretinitis included a multifocal choroiditis with (1) the characteristic appearance of a bilateral multifocal choroiditis with cream-colored or yellow-orange, oval or round choroidal spots ("birdshot" spots); (2) absent to mild anterior chamber inflammation; and (3) absent to moderate vitreous inflammation; or multifocal choroiditis with positive HLA-A29 testing and either classic "birdshot spots" or characteristic imaging on indocyanine green angiography. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for birdshot chorioretinitis were 10% in the training set and 0% in the validation set.

Conclusions: The criteria for birdshot chorioretinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

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Conflict of interest statement

Conflict of Interest: Douglas A. Jabs: none; Antoine P. Brezin: none; Ralph D. Levinson: none; Peter McCluskey: none; Neal Oden: none; Alan G. Palestine: none; Russell W. Read: none; Jennifer E. Thorne: Dr. Thorne engaged in a portion of this research as a consultant and was compensated for the consulting service; Brett E. Trusko: none; Albert Vitale: none; Susan E. Wittenberg: none.

Figures

Figure 1.
Figure 1.
Fundus photograph of a case of birdshot chorioretinitis, demonstrating multifocal yellow-orange, ovoid, choroidal spots.
Figure 2.
Figure 2.
Indocyanine green angiogram of a case of birdshot chorioretinitis, demonstrating multifocal, hypofluorescent choroidal spots.
See this image and copyright information in PMC

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