Management of autoimmune retinopathies with immunosuppression.

Publisher: American Medical Association Country of Publication: United States NLM ID: 7706534 Publication Model: Print Cited Medium: Internet ISSN: 1538-3601 (Electronic) Linking ISSN: 00039950 NLM ISO Abbreviation: Arch Ophthalmol Subsets: MEDLINE

Original Publication: Chicago, IL : American Medical Association

Autoimmune Diseases/*drug therapy ; Azathioprine/*therapeutic use ; Cyclosporine/*therapeutic use ; Immunosuppressive Agents/*therapeutic use ; Prednisone/*therapeutic use ; Retinal Diseases/*drug therapy; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autoantibodies/blood ; Autoantigens/immunology ; Autoimmune Diseases/immunology ; Blotting, Western ; Child ; Drug Therapy, Combination ; Electrophoresis, Polyacrylamide Gel ; Female ; Humans ; Macular Edema/drug therapy ; Macular Edema/immunology ; Male ; Middle Aged ; Paraneoplastic Syndromes/drug therapy ; Paraneoplastic Syndromes/immunology ; Retinal Diseases/immunology ; Retrospective Studies ; Treatment Outcome

Objective: To report the results of treating autoimmune retinopathy (AIR) with immunosuppression therapy.
Methods: Retrospective review of 30 consecutive patients with AIR followed for 3 to 89 months (median, 17 months) who were treated with immunosuppression (systemic or local). Subgroups were cancer-associated retinopathy (CAR), nonparaneoplastic AIR (npAIR), and npAIR with cystoid macular edema (npAIR/CME). Outcome measures were improvement of Snellen visual acuity by at least 2 lines, expansion of the visual field area by more than 25%, and resolution of CME.
Results: Overall, 21 of 30 patients (70%) showed improvement. All 6 CAR patients, 7 of 13 (54%) with npAIR, and 8 of 11 (73%) with npAIR/CME showed improvement. Five of 21 patients (24%) had improvement in visual acuity, 15 of 21 (71%) had expansion of visual field area, and 6 of 11 (55%) had resolution of CME. Twenty-six of 30 patients exhibited diffuse retinal atrophy without pigment deposits. An autoimmune family history was common in all the groups: npAIR, 69% (9 of 13); npAIR/CME, 64% (7 of 11); and CAR, 50% (3 of 6).
Conclusions: Long-term treatment with immunosuppression resulted in clinical improvement in all subgroups of AIR. The most responsive subgroup was CAR; the least was npAIR. These results challenge the commonly held belief that AIR is untreatable.

Comment in: Arch Ophthalmol. 2009 Apr;127(4):573-5. (PMID: 19365043)

0 (Autoantibodies)
0 (Autoantigens)
0 (Immunosuppressive Agents)
83HN0GTJ6D (Cyclosporine)
MRK240IY2L (Azathioprine)
VB0R961HZT (Prednisone)

Date Created: 20090415 Date Completed: 20090428 Latest Revision: 20220408

20240829

10.1001/archophthalmol.2009.24

19365013