Optic Neuropathy with Positive Anti-retinal Antibodies

Abstract

　We herein describe the clinical outcome of a patient with bilateral optic neuropathy and positive anti-retinal antibodies. A 48-year-old man suffering from visual impairment in both eyes was referred to our hospital. His best-corrected visual acuity was light perception for OD and 0.07 for OS, and the critical flicker fusion frequency was untestable for OD and 15 Hz for OS. Fundoscopy revealed pallor in the right optic disc and swelling in the left optic disc. Electroretinogram amplitude was slightly decreased in both eyes, whereas enhanced orbital MRI showed no abnormalities in bilateral optic nerves. Furthermore, systemic examination indicated no malignancy. Although the cause of his bilateral optic neuropathy was unknown, western blotting using patient serum and rat retinal extract revealed 100 kD and 150 kD bands, respectively. In addition, immunostaining of rat retina with patient serum displayed staining of the retinal ganglion cell layer. The patient was ultimately diagnosed to have autoimmune retinopathy due to the presence of retinal autoimmune antibodies. Generally, autoimmune retinopathy is characterized by photoreceptor dysfunction. However, this patient showed optic atrophy and immunostaining of the retinal ganglion cell layer, suggesting a different pathogenesis from that typical noted.