Optical coherence tomography findings in autoimmune retinopathy

Abstract

Purpose: To report optical coherence tomography (OCT) features of patients with autoimmune retinopathy.

Design: Consecutive case series.

Method: Eight patients who presented with unexplained loss of central vision, visual field defects, and/or photopsia were diagnosed with autoimmune retinopathy based on clinical features, electroretinogram (ERG) findings, and serum antiretinal antibody analysis. All patients underwent OCT testing of the macula and nerve fiber layer (NFL).

Results: Outer retinal abnormalities and/or decreased macular thickness on OCT were seen in all patients. Macular OCT showed reduced central macular and foveal thicknesses in 6 patients (mean thickness 143±30 μm and 131±29 μm respectively). In all but 1 patient, loss of the photoreceptor layer or disruption of the photoreceptor outer and inner segment junction was noted. Three patients showed only mild to moderate focal NFL loss.

Conclusions: Retinal atrophy and reduced macular thickness on OCT are predominant features in patients with autoimmune retinopathy. OCT provides objective measures of retinal damage and may offer clues toward understanding the mechanism of visual dysfunction and the diagnosis of autoimmune retinopathy.

FIGURE 1

Macular optical coherence tomography of the right (Left) and left eye (Right) of a patient with anti-α-enolase-positive autoimmune retinopathy (Patient 2) shows marked retinal thinning and atrophy of the outer retinal layers, including the outer nuclear layer and photoreceptors, in both eyes.

FIGURE 2

Macular optical coherence tomography of a patient with autoimmune retinopathy (Patient 8) shows preservation of the outer retina and outer nuclear layer with normal central macular thickness in both eyes. However, disruption of the photoreceptor inner/outer segment junction is evident in the right eye only (Left). Note normal photoreceptor inner/outer segment junction in the left eye (Right, arrow).

FIGURE 3

Humphrey automated 24-2 visual field of the right eye of a patient with autoimmune retinopathy (Patient 8) before (Left) and after (Right) treatment with 2 cycles of intravenous immunoglobulin. Note the improvement in visual field after treatment. This was associated with an improvement in visual acuity and multifocal electroretinography and a drop in the antiretinal antibody titer.