Autoimmune retinopathy in the absence of cancer.
OBJECTIVE
To report the clinical and immunologic features of two patients with progressive retinal degeneration and circulating antiretinal antibodies without systemic malignancy.


METHODS
Two patients were followed up for 5 to 7 years. Comprehensive medical and ophthalmic examinations and visual function testing included manual perimetry and standardized electroretinography. Patient sera were tested for antiretinal antibodies by Western blot and immunoperoxidase indirect cytochemistry techniques.


RESULTS
Two patients had family history of autoimmune disease. Each had severe monocular visual loss with photopsia, a ring scotoma, and abnormal electroretinogram despite a normal-appearing ocular fundus. One had a flat electroretinogram; the other had inner retina dysfunction, with selective b wave loss and abnormal oscillatory potentials. Both patients' sera had antiretinal antibodies that specifically labeled the inner plexiform layer of donor retina by indirect immunoperoxidase testing. Neither had any sign of cancer.


CONCLUSIONS
In two patients without systemic malignancy, the symptoms, perimetric findings, and normal fundus appearance resembled cancer associated retinopathy. Electroretinography and antibody findings indicating dysfunction of the inner retina are distinct from those of cancer-associated retinopathy. These two cases raise the possibility of an autoimmune mechanism for retinal degeneration that is not cancer associated. Further study is necessary to determine the role of antiretinal antibodies in these patients.
Mizener
J B
JB
Department of Ophthalmology, University of Iowa, Iowa City 52242, USA.
Kimura
A E
AE
Adamus
G
G
Thirkill
C E
CE
Goeken
J A
JA
Kardon
R H
RH
D000328:Adult; D000951:Antigens, Neoplasm / Q000276:immunology; D001323:Autoantibodies / Q000032:analysis*; D001324:Autoantigens / Q000276:immunology*; D001327:Autoimmune Diseases / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D015153:Blotting, Western; D002135:Calcium-Binding Proteins / Q000276:immunology; D018450:Disease Progression; D004596:Electroretinography; D004797:Enzyme-Linked Immunosorbent Assay; D005136:Eye Proteins; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D051597:Hippocalcin; D006801:Humans; D007124:Immunoenzyme Techniques; D008074:Lipoproteins; D008213:Lymphocyte Activation; D008297:Male; D009369:Neoplasms / Q000276:immunology; D009419:Nerve Tissue Proteins; D051603:Recoverin; D012160:Retina / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D012162:Retinal Degeneration / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D014792:Visual Acuity; D014794:Visual Fields
D000951:Antigens, Neoplasm; D001323:Autoantibodies; D001324:Autoantigens; D002135:Calcium-Binding Proteins; D005136:Eye Proteins; D008074:Lipoproteins; D009419:Nerve Tissue Proteins; C496731:RCVRN protein, human; D051603:Recoverin; D051597:Hippocalcin