Autoimmune Retinopathy: Three Case Reports

Jo Lynch BOrthOphthSc

Eye Surgery Associates, Melbourne, Australia

Autoimmune retinopathy (AIR) is an uncommon condition which should be considered when a patient presents with unexplained visual loss. The three main forms are melanoma-associated retinopathy (MAR), cancer-associated retinopathy (CAR) and non-paraneoplastic autoimmune retinopathy (npAIR). The visual loss is painless and can decline either rapidly or gradually. Symptoms may include reduced best-corrected visual acuity (BCVA), photopsias which are often described as flickering or shimmering effects, visual field loss, nyctalopia, loss of colour vision and delayed adaptation to changing light conditions. AIR is usually, but not always, bilateral and may be asymmetrical. The fundus exam and optical coherence tomography (OCT) are usually normal, however the electroretinogram (ERG) results are abnormal. The damage to retinal photoreceptors occurs when antiretinal antibodies are created by an autoimmune reaction to retinal proteins. Serology may reveal the presence of a range of anti-retinal antibodies but is not diagnostic without concurrent clinical manifestations. Immunosuppressive treatment may limit disease progression. Patients with AIR are often misdiagnosed or have their diagnosis delayed. In patients with unexplained visual loss, particularly if their symptoms include photopsias, it is important to take a comprehensive medical history and undertake extensive clinical testing, including BCVA, OCT, visual field, colour vision testing, ERG and antiretinal antibody serology. This paper presents a case each of CAR, MAR and npAIR.