Autoimmune retinopathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S
Overview
Medical Therapy
Currently no standard treatment protocol exists for autoimmune retinopathy (AIR). However, various treatment options have been described in the literature, and they are as follows:
Systemic and/or topical corticosteroids
Immunosuppression through systemic and/or topical (intravitreal/sub-tenon/depot) corticosteroids. For all cases of AIR initiate steroids (local or systemic) and/or with antimetabolites/T-cell inhibitors, as the first or second-line treatment respectively, after systemic management of the underlying autoimmune disease.
Initiate a short-term treatment trial with intravitreal or sub-tenon triamcinolone (40-80 mg, two injections over a span of 8 months), before starting systemic steroids (60-80 mg oral prednisone daily); this aids in both confirmation of the diagnosis as well as avoidance of adverse effects of the treatment.
Immunomodulators
Immunomodulators like cyclosporine (calcineurin inhibitor which prevents IL-2 transcription), infliximab (anti-TNFα antibody), mycophenolate mofetil (IMP dehydrogenase inhibitor, preventing purine synthesis), azathioprine (purine antimetabolite).
Biological agents
Biological agents such as monoclonal antibodies like rituximab (anti-CD20 antibody), alemtuzumab (anti-CD52 antibody), ipilimumab (antagonist antibody against cytotoxic T-lymphocyte antigen-4), tocilizumab (anti-IL-6 receptor antibody), sarilumab (anti-IL-6 receptor antibody)
Intravenous immunoglobulin (IVIG), and Plasmapheresis
Intravenous immunoglobulin (IVIG), plasmapheresis are effective if given before the onset of irreversible neuronal degeneration.
IVIG has several mechanisms of action like, neutralization of autoantibodies, binding of complement components, inhibition of dendritic cells maturation, modulation of intercellular adhesion, and contribution of IgG4.
Antioxidants
Antioxidant vitamins like lutein, Vitamin C, Vitamin E, and beta carotene (in non-smokers) also play a role in stabilizing retinal degeneration and disease course.
To monitor the response to management, follow-up testing with ERG, visual field testing, visual acuity, OCT, and colour vision testing may be conducted every 3 to 6 months.