Plasma Antiretinal Autoantibody Profiling and Diagnostic Efficacy in Patients With Autoimmune Retinopathy

Clinical Outcome of Immunosuppressive Therapy in Autoimmune Retinopathy

PURPOSE

To evaluate the long-term outcomes of immunosuppressive therapy in patients with autoimmune retinopathy (AIR) and assess differences based on anti-retinal antibody (ARA) profiles.

METHODS

A retrospective multicenter observational study was conducted on 26 AIR patients who received immunosuppressive therapy for at least six months. Clinical information, ophthalmic examinations, and profiles of detected ARAs were collected between March 2011 and November 2023. Comparisons of ophthalmic examination results were performed pre- and post-immunosuppressive therapy. Association and logistic regression analyses were conducted to determine the relationship between ARA profiles and functional and anatomical outcomes.

RESULTS

The mean duration of immunosuppressive therapy was 25.3   ±   30.4 months. Among 52 eyes (26 patients), 61% (32 eyes) exhibited worsening best-corrected visual acuity (BCVA), while 10% (5 eyes) showed improvement. The mean BCVA declined significantly from 0.67 ± 0.77 to 1.07 ± 1.02 logMAR (p < 0.001). Optical coherence tomography (OCT) revealed worsening in 35% (18 eyes), improvement in 4% (2 eyes), and no change in 61% (32 eyes). No improvement was observed in the amplitude of any electroretinogram component. Visual field tests indicated worsening in 66% (19/29 eyes). Notably, patients with recoverin antibodies had a higher risk of visual impairment. Multivariable logistic regression analysis revealed no significant associations between the number of ARAs and BCVA or OCT worsening.

CONCLUSION

Despite prolonged immunosuppressive therapy, patients with AIR experienced poor functional and anatomical outcomes. The presence of recoverin antibodies was associated with a higher risk of visual impairment, while the number of ARAs did not significantly correlate with BCVA or OCT worsening.

Guidelines for the Diagnosis, Management, and Study of Autoimmune Retinopathy from the American Academy of Ophthalmology's Task Force

PURPOSE

The American Academy of Ophthalmology created a task force to advance the understanding of autoimmune retinopathy (AIR) and provide guidelines on the diagnosis and management of this complex disorder.

DESIGN

A search on PubMed and Google Scholar of English-language studies was conducted without date restrictions. The Task Force reviewed the current literature and formulated an expert consensus on the management of AIR as well as recommendations for future efforts to improve our understanding of this condition.

RESULTS

Key clinical and imaging features are discussed, and a new diagnostic framework is proposed based on likelihood of AIR (probable AIR, possible AIR, and unlikely AIR) to provide a more standardized approach for categorizing disease. Patients who possess all the following features can be categorized as having probable AIR: (1) signs of disease progression based on subjective symptoms and objective testing within six months, (2) examination with less than 1+ anterior chamber or vitreous cell/haze, (3) optical coherence tomography (OCT) with outer retinal disruption and loss of the external limiting membrane/outer retinal bands/ellipsoid zone often relatively sparing the fovea, (4) characteristic fundus autofluorescence (FAF) abnormalities, (5) full field ERG with reduction of both rod and cone responses, and (6) positive anti-retinal antibodies. Those with some but not all of these features, or with otherwise atypical presentations, can be classified as possible AIR. Features that would make AIR unlikely and should elicit strong suspicion for alternative diagnoses are: (1) slowly progressive symptoms or changes on testing taking place over years, (2) retinal examination with bone spicules, retinal vascular sheathing, or retinal hemorrhages, (3) examination with more than 1+ anterior chamber or vitreous cell/haze, (4) OCT changes predominantly at the level of the RPE or areas of focal/sharply delineated outer retinal/RPE atrophy, (5) fluorescein angiography with diffuse retinal vasculitis or large areas of non-perfusion, or (6) a normal full-field electroretinogram (even with an abnormal multifocal electroretinogram).

CONCLUSIONS

These criteria will allow for better classification of patients reported in the literature and improve communication between clinicians. Further study is necessary to optimize the approach for managing AIR and will require collaborative multi-center efforts.

The Relationship of Serum Diabetes Antibodies With the Development of Early Diabetic Retinopathy Findings in Children With Type 1 Diabetes Mellitus

PURPOSE

To explore how serum diabetes autoantibodies are related to the development of early diabetic retinopathy in children with type 1 diabetes mellitus.

METHODS

In this prospective and observational study, 62 patients with type 1 diabetes mellitus who had not yet developed clinical diabetic retinopathy were followed up for at least 5 years. Healthy volunteers aged 10 to 20 years were also included. Insulin, pancreatic islet cells, and glutamic acid decarboxylase (GAD) autoantibodies were measured with an RIA kit at the time of type 1 diabetes mellitus diagnosis. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early diabetic retinopathy among the groups. Patients' OCTA findings were compared with those of healthy volunteers. The obtained data were analyzed via IBM SPSS Statistics for Windows, version 27.0. Spearman's rank correlation test and regression analysis were performed to determine independent predictors of OCTA and type 1 diabetes mellitus parameters.

RESULTS

Eighteen boys and 44 girls with type 1 diabetes mellitus with a median age of 15.6 years (range: 10.08 to 20.88 years) were evaluated. Healthy control participants with a median age of 15.3 years (range: 14.2 to 18.2 years) were also included. The mean FAZ was greater in the type 1 diabetes mellitus group than in the healthy control group (P = .013 and .119, respectively). The mean PVD was significantly lower in the type 1 diabetes mellitus group than in the healthy control group. There was no significant correlation between serum diabetes autoantibodies (GAD and insulin autoantibodies) and FAZ or PVD (FAZ and GAD; r = 0.138, P = .286, FAZ and anti-insulin; r = 0.100, P = .441, PVD and GAD; r = -0.151, P = .24, PVD and anti-insulin; r = -0.087, P = .499).

CONCLUSIONS

Type 1 diabetes mellitus in children without clinically detectable diabetic retinopathy is associated with impaired retinal microcirculation and irregularities at the FAZ margin. Impaired retinal microcirculation and irregularities were associated with glycated hemoglobin levels in the study group. Thus, studies with larger patient series are needed. [J Pediatr Ophthalmol Strabismus. 2025;62(2):135-142.].

TOWARD AN IMAGING-CENTRIC DEFINITION OF NONPARANEOPLASTIC AUTOIMMUNE RETINOPATHY

PURPOSE

To explore characteristic imaging features of nonparaneoplastic autoimmune retinopathy (npAIR) to augment diagnostic criteria.

METHODS

This is a retrospective cohort study of patients with npAIR evaluated at the Emory Eye Center between 2013 and 2019. Multimodal fundus images were evaluated to characterize the evolution of the disease.

RESULTS

Twenty-one eyes of 12 patients were classified as having npAIR. Five patients (42%) were female, with median (range) age of 59 years (45-85 years). Median baseline visual acuity was 20/30 (20/20 to hand motions). Disease was asymmetric in 11 patients (92%). Common imaging findings included absence of bone spicules (86% of affected eyes), presence of attenuated vessels (86%), and speckled hypoautofluorescence in perimacular and perivenular regions. Three eyes were noted to present early with subtle splotchy fundus autofluorescence abnormality, ultimately developing characteristic speckled perimacular hypoautofluorescence. On optical coherence tomography, 18 eyes (86%) had loss of outer retinal bands with relative foveal sparing and a tapered transition zone.

CONCLUSION

Many eyes with npAIR exhibit a subacute, asymmetric, generalized photoreceptor degeneration featuring outer retinal atrophy with relative foveal sparing, retinal vascular attenuation, absence of bone spicules, and speckled hypoautofluorescence often in a perimacular and perivenular distribution. Findings of this study augment diagnostic criteria to improve specificity and accessibility of testing for npAIR.

Association of Circulating Antiretinal Antibodies With Clinical Outcomes in Retinitis Pigmentosa

Purpose

To determine if circulating antiretinal antibodies (ARAs) differ between patients affected by retinitis pigmentosa (RP) and control participants and to assess whether ARAs are associated with clinical outcomes in patients with RP.

Methods

Cross-sectional study involving a group of patients clinically diagnosed with RP and a control group of healthy participants. Serum autoantibodies against enolase, heat shock protein 70 (HSP70), and carbonic anhydrase II (CAII) were tested in all participants using Jess capillary Western blot. We compared ARA prevalence between the RP and control groups and investigated the association of serum ARA positivity with macular edema and vitreomacular disorders in patients affected by RP.

Results

Thirty-six patients affected by RP and a control group of 39 healthy individuals were included. Overall, at least one ARA positivity was detected in 89% and 80% of participants in the RP and control groups, respectively. We observed a similar prevalence of anti-CAII and anti-enolase ARA between patients and controls (P = 0.87 and P = 0.35, respectively). Sera from patients with RP tested positive for anti-HSP70 ARAs more frequently than those from controls (53% vs. 36%), albeit without reaching statistical significance (P = 0.29). Among the 72 eyes with RP, 25% presented with macular edema (most often bilateral) and 33% with epiretinal membrane and/or lamellar macular hole. None of the three ARAs was associated with an increased risk of any macular complications in eyes affected by RP (all P > 0.05).

Conclusions

The prevalence of circulating ARAs against enolase, HSP70, and CAII is similar between patients affected by RP and healthy individuals. Our results provide evidence against the association of ARAs with macular edema and vitreomacular interface disorders in RP.