Clinical Outcome of Immunosuppressive Therapy in Autoimmune Retinopathy

Purpose: To evaluate the long-term outcomes of immunosuppressive therapy in patients with autoimmune retinopathy (AIR) and assess differences based on anti-retinal antibody (ARA) profiles. Methods: A retrospective multicenter observational study was conducted on 26 AIR patients who received immunosuppressive therapy for at least six months. Clinical information, ophthalmic examinations, and profiles of detected ARAs were collected between March 2011 and November 2023. Comparisons of ophthalmic examination results were performed pre- and post-immunosuppressive therapy. Association and logistic regression analyses were conducted to determine the relationship between ARA profiles and functional and anatomical outcomes. Results: The mean duration of immunosuppressive therapy was 25.3 ± 30.4 months. Among 52 eyes (26 patients), 61% (32 eyes) exhibited worsening best-corrected visual acuity (BCVA), while 10% (5 eyes) showed improvement. The mean BCVA declined significantly from 0.67 ± 0.77 to 1.07 ± 1.02 logMAR (p < 0.001). Optical coherence tomography (OCT) revealed worsening in 35% (18 eyes), improvement in 4% (2 eyes), and no change in 61% (32 eyes). No improvement was observed in the amplitude of any electroretinogram component. Visual field tests indicated worsening in 66% (19/29 eyes). Notably, patients with recoverin antibodies had a higher risk of visual impairment. Multivariable logistic regression analysis revealed no significant associations between the number of ARAs and BCVA or OCT worsening. Conclusion: Despite prolonged immunosuppressive therapy, patients with AIR experienced poor functional and anatomical outcomes. The presence of recoverin antibodies was associated with a higher risk of visual impairment, while the number of ARAs did not significantly correlate with BCVA or OCT worsening.