Birdshot retinochoriodopathy (BSRC) is characterized by its hypopigmented choroidal lesions ¼ to ½ optic disc diameter, clustered around the optic nerve, radiating towards the periphery, nearly always involving inferior and nasal peripapillary area, in a pattern similar to the gunshot spatter from birdshot. The lesions can be diffuse, macula predominant, macula sparing, or asymmetric. The disease accounts for 1-2% of all types of uveitis, primarily affecting Caucasian females between 40-60 years old. The early stage of the disease is characterized by retinal vascular leakage; the middle stage by prominent birdshot lesions; and the late stage by the presence of cystoid macular edema (84% in BSRC vs. 30% in other types of uveitis)  , vascular attenuation, RPE changes, optic nerve atrophy, and subretinal neovascularization.
APMPEE is self-limiting with a generally good prognosis with the majority of affected patients achieving a visual acuity of 20/40 or better. Visual recovery typically takes 4 weeks, but can extend to 6 months in some patients. A recent review by Fiore T el al. analyzed 183 articles related to APMPPE and concluded that 25% of patients had a visual acuity of 20/50 or worse. Foveal involvement confers a worse visual prognosis. There is no current consensus on treatment although steroids have been utilized and reported to be beneficial in cases of foveal involvement and associated CNS vasculitis. Future studies are needed to evaluate dosage, duration, and effects of steroid treatment. All patients with a new diagnosis of APMPPE should receive a full neurologic and systemic work-up to evaluate for CNS vasculitis and other associated systemic conditions.