自身免疫性视网膜病(AIR)是一种罕见且仍鲜为人知的免疫介导疾病,可能因循环中针对视网膜的自身抗体而引起炎症。它可能与患者或家庭成员的自身免疫性疾病病史或个体中肿瘤疾病的存在有关。该疾病可细分为副肿瘤和非副肿瘤AIR。当与黑色素瘤有关时,它被称为MAR,当与其他癌症有关时,它被称为汽车。AIR的确切患病率未知。它主要影响老年人。患者表现为双侧和不对称暗点,照片,视野缺陷,在晚期发作时迅速进行性视力丧失。在初始阶段,眼底检查不明显,在后期阶段,有有限的视网膜上皮病变和血管衰减,有或没有视盘苍白,与眼内炎症相关或不相关,并且没有变性视网膜疾病的证据。应进行详细的回忆和实验室检查的临床研究,以寻找相关的肿瘤。眼科和补充检查,如全视野视网膜电图,光学相干层析成像,视野和眼底自发荧光,帮助诊断。应要求进行血液检查以寻找自身抗体。管理包括长期免疫抑制,它可以与抗氧化维生素结合。总的来说,预后不确定,所以这种疾病仍然需要更好的理解。应该进行更多的研究来改进诊断措施,并确定可以保持甚至恢复视力的具体管理。
Autoimmune retinopathy (AIR) is a rare and still poorly understood immune-mediated disease that may cause inflammation from circulating autoantibodies against the retina. It may be related to history of autoimmune disease in the patient or in a family member or the presence of neoplastic disease in the individual. The disease may be subdivided into paraneoplastic and non-paraneoplastic AIR. When related to melanoma, it is referred to as MAR, and when related to other cancers, it is called CAR. The exact prevalence of AIR is unknown. It mainly affects older adults. Patients present with bilateral and asymmetric scotomas, photopsias, visual field defects, with rapidly progressive visual loss in late onset. In the initial stage, fundus examination is unremarkable, and in late stages, there is limited retinal epitheliopathy and vascular attenuation, with or without optic disc pallor, associated or not with intraocular inflammation and with no evidence of degenerative retinal disease. A clinical investigation with detailed anamnesis and laboratory tests should be performed to search for an associated neoplasm. Ophthalmologic and complementary examinations such as full-field electroretinogram, optical coherence tomography, visual field and fundus autofluorescence, help the diagnosis. Blood tests to search for autoantibodies should be requested. Management consists of prolonged immunosuppression, which may be combined with antioxidant vitamins. In general, the prognosis is uncertain, so the disease still needs to be better understood. More studies should be performed to improve diagnostic measures and define specific management that could preserve or even restore vision.