Management of Autoimmune Retinopathies With Immunosuppression
Management of Autoimmune Retinopathies With Immunosuppression
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DOI：
10.1001/archophthalmol.2009.24
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发表时间：
2009-04-01
影响因子：
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通讯作者：
Heckenlively, John R.
中科院分区：
文献类型：
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作者：
Ferreyra, Henry A.;Jayasundera, Thiran;Heckenlively, John R.
目的：报道免疫抑制治疗自身免疫性视网膜病变(AIR)的疗效。方法：对30例AIR患者进行全身性或局部性免疫抑制治疗，随访3~个月，中位数17个月。亚组包括癌症相关性视网膜病变(CAR)、非副肿瘤性AIR(NpAIR)和npAIR伴黄斑囊样水肿(npAIR/CME)。观察指标：Snellen视力提高2行以上，视野面积扩大25%以上，CME分辨率提高。结果：30例患者中有21例(70%)有改善。6例CAR患者中，npAIR组7例(54%)，npAIR/CME组11例(73%)。视力提高5例(24%)，视野扩大15例(71%)，CME分辨率6例(55%)。30例患者中26例表现为弥漫性视网膜萎缩，无色素沉积。所有患者均有自身免疫家族史：npAIR，69%(9/13)；npAIR/CME，(7/11)；CAR，50%(3/6)。结论：长期免疫抑制治疗可改善AIR各亚型的临床症状。反应最快的亚群是CAR，最小的是npAIR。这些结果挑战了人们普遍认为的空气无法治愈的信念。
Objective: To report the results of treating autoimmune retinopathy (AIR) with immunosuppression therapy.Methods: Retrospective review of 30 consecutive patients with AIR followed for 3 to 89 months (median, 17 months) who were treated with immunosuppression (systemic or local). Subgroups were cancer-associated retinopathy (CAR), nonparaneoplastic AIR (npAIR), and npAIR with cystoid macular edema (npAIR/CME). Outcome measures were improvement of Snellen visual acuity by at least 2 lines, expansion of the visual field area by more than 25%, and resolution of CME.Results: Overall, 21 of 30 patients (70%) showed improvement. All 6 CAR patients, 7 of 13 (54%) with npAIR, and 8 of 11 (73%) with npAIR/CME showed improvement. Five of 21 patients (24%) had improvement in visual acuity, 15 of 21 (71%) had expansion of visual field area, and 6 of 11 (55%) had resolution of CME. Twenty-six of 30 patients exhibited diffuse retinal atrophy without pigment deposits. An autoimmune family history was common in all the groups: npAIR, 69% (9 of 13); npAIR/CME, 64% (7 of 11); and CAR, 50% (3 of 6).Conclusions: Long-term treatment with immunosuppression resulted in clinical improvement in all subgroups of AIR. The most responsive subgroup was CAR; the least was npAIR. These results challenge the commonly held belief that AIR is untreatable.