Progressive visual failure can be secondary to autoimmune retinopathy (AIR). Presentation include progressive nyctalopia and peripheral field constriction. We present two patients with autoimmune retinopathy and their clinical progression.
A 70-year-old lady was referred to the neuroimmunology clinic with progressive nyctalopia and periorbital pain to exclude the possibility of an immune-mediated retinopathy. Visual acuity was 6/18 bilaterally with peripheral visual constriction. OCT showed disruption of the photoreceptor layers. A retinal antibody screen showed positive anti-Recoverin B antibodies. In view of the paraneoplastic association of this antibody, a thorough search for an underlying tumour was performed (CT, PET) and endobronchial ultrasound guided biopsy showed high grade neuro-endocrine small cell lung cancer. Oncological treatment coupled with IVIg therapy stabilised visual function for over 18 months at last follow-up.
A 47-year-old gentleman was referred with a three month history of bilateral visual decline and slightly altered personality. Retinal antibody screen showed cytoplasmic staining of inner nuclear layer. Extensive screening for an underlying neoplasia has been negative.
AIR can be cancer-associated (CAR), melanoma-associated (MAR) or non-paraneoplastic (nPAIR). Presence of Recoverin B antibodies should prompt thorough screening for underlying neoplasia. Treatment of cancer coupled with immunomodulatory therapy may help in halting progressive visual loss.