Original ArticlesAssociation of antiretinal antibodies and cystoid macular edema in patients with retinitis pigmentosa☆
Section snippets
Patients and methods
In a prospective study, all patients were evaluated consecutively at the Jules Stein Eye Institute at the University of California at Los Angeles. During a 19-month period, all patients found to have bilateral macular cysts and retinitis pigmentosa by direct and 90-diopter indirect biomicroscopic ophthalmoscopy were asked to donate a blood sample after giving informed consent. After the serum was separated from the clot, the sample was sent by overnight express to the University of Florida,
Results
Twenty-seven (90%) of 30 patients with retinitis pigmentosa with cystoid macular edema had anti–retinal protein antibody activity, compared with three (6%) of 50 normal controls (P < .001) and only four (13%) of 30 control patients with retinitis pigmentosa (P < .001, all two-tailed chi-square test; Table).
Among the patients with retinitis pigmentosa with cystoid macular edema, 18 (67%) of the 27 had two or more immunolabeled bands (Table). The most common retinal proteins showing antigenicity
Discussion
The strong correlation between antiretinal antibodies and the presence of cystoid macular edema in patients with panretinal degeneration raises more questions than this study answers. The sequence of events and predisposing factors that lead retinal proteins to become antigenic will be the source of future investigations. A breakdown of the blood-retinal barrier during the retinal degenerative process could presumably release retinal proteins into the circulation that could be antigenic. The
Acknowledgements
Michael Goldbaum, MD, referred Case 18 for study. Howard Rampersaud assisted with antinuclear antibody determinations. Paul Hargrave, PhD, reviewed the manuscript and provided advice.
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Supported in part by the RP Foundation Fighting Blindness, Baltimore, Maryland; National Institutes of Health Core Facilities grant EY 08571; a Senior Distinguished Scientist Award (J.R.H.); and an unrestricted departmental award from Research to Prevent Blindness, Inc, New York, New York.