Correlation between Antiretinal Antibodies and OCT Manifestations in Nonparaneoplastic Autoimmune Retinopathy

Purpose: This study sought to examine the correlation between antiretinal antibodies (ARAs) and OCT manifestations in patients diagnosed with nonparaneoplastic autoimmune retinopathy (npAIR). Design: A retrospective, observational case series. Participants: Fifty-five patients (92 eyes) diagnosed with probable or possible npAIR. Methods: Patients underwent comprehensive evaluation, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus photography, autofluorescence, OCT scanning, and electroretinogram. Blood samples were analyzed for the presence of ARAs using Western Blot, including anti-recoverin (ARc), anti-α-enolase (AeNO), anti-carbonic anhydrase II (ACA), and anti-CRMP5 (AC5). Statistical analyses included the Kruskal-Wallis test (logarithm of the minimum angle of resolution BCVA) and 1-way analysis of variance (central retinal thickness [CRT]) for group comparisons. Diagnostic performance of key OCT features was assessed. Main Outcome Measures: Multimodal imaging, BCVA, and CRT of patients diagnosed with npAIR. Results: Among the 55 npAIR patients, 52.7% were positive for a single tested antibody, while 25.5%, 14.5%, and 7.3% had two, three, or four of the tested antibodies, respectively. Central retinal thickness and BCVA were significantly worse in most ARA-positive groups versus controls. However, the AeNO(+) subgroup showed the best-preserved CRT and BCVA. The AeNO(+) eyes predominantly exhibited inner retinal (ganglion cell complex/retinal nerve fiber layer) thinning (66.7%). The ACA(+) and ARc(+) eyes showed patterns of diffuse outer retinal degeneration (50% and 75%, respectively). The AC5(+) eyes uniquely presented outer plexiform layer (OPL) "double-layer signs" (45.8%) and "retinitis pigmentosa-like" changes (25%). Analysis of diagnostic performance revealed that "inner retinal thinning" had moderate sensitivity (66.7%) for AeNO, while "OPL double-layer signs" showed perfect specificity (100%) for AC5 within our cohort. Conclusions: This study provides valuable insights into the correlation between ARA profiles and specific OCT patterns in npAIR patients. The findings advance our understanding of npAIR pathogenesis and highlight the potential of OCT imaging and ARA profiling in the diagnosis and management of this complex condition. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.