Original Articles
Association of antiretinal antibodies and cystoid macular edema in patients with retinitis pigmentosa

https://doi.org/10.1016/S0002-9394(98)00446-2Get rights and content

Abstract

PURPOSE: To report the association of antiretinal antibodies in patients with bilateral cystoid macular edema and retinitis pigmentosa.

METHODS: In a prospective study, 30 consecutive patients with bilateral cystoid macular edema and retinitis pigmentosa were tested for antiretinal antibodies. As control subjects, 30 consecutive patients with retinitis pigmentosa who did not have cystoid macular edema and 50 normal subjects without retinitis pigmentosa or cystoid macular edema were tested for antiretinal antibodies. Laboratory personnel performing the antiretinal antibody testing were masked regarding the diagnosis of each patient.

RESULTS: Twenty-seven (90%) of 30 patients with retinitis pigmentosa with cystoid macular edema had antiretinal 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).

CONCLUSIONS: We found a significant association between cystoid macular edema and the presence of circulating antiretinal antibodies in patients who presented with retinitis pigmentosa and cystoid macular edema. This study suggests that patients with retinitis pigmentosa with cystoid macular edema may have an autoimmune process that is contributing to the formation of cystoid macular edema in retinitis pigmentosa, but to date, there is no direct evidence that the cystoid macular edema is caused by the antiretinal antibodies.

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.

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