Ocular autoantibodies??

[NSAspy]

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Maybe a silly question, but I guess this is the time to ask (before I start ophtho residency), anyhoo I'm curious about whether there's an ophthalmic analog to the "antisperm antibodies phenomena" following vasectomy, for ocular surgeries like cataract, lasik, glaucoma surgeries etc? Afterall the eyes and testes are both immune-privileged sites...

I know of sympathetic ophthalmia s/p eye trauma, but do antibodies against lens material form s/p CEIOL or anti-photoreceptor antibodies s/p RD? If so, is there any clinical sequelae from such antibodies?

thanks

 

[MstaKing10]

Best example I think would be sympathetic ophthalmia which has been rarely reported after surgery (more common with trauma). Violation of the lens capsule can lead to a severe inflammatory response but this has a different pathophysiology.

 

[DrZeke]

Best example I think would be sympathetic ophthalmia which has been rarely reported after surgery (more common with trauma). Violation of the lens capsule can lead to a severe inflammatory response but this has a different pathophysiology.

I thought that nowadays the most common cause of SO is vitrectomy.

 

[johnl19]

Autoimmunity to normally immune privileged ocular tissue is important in ophthalmology.

Maybe the best example and most classic is what has already been mentioned, sympathetic ophthalmia (SO). Though the exact mechanism/etiology is not known it is thought to be to either 1) introduction of foreign antigen such as an infectious agent causing a molecular mimicry immune response and/or 2) exposure of previously sequestered immune privileged tissue (e.g. uveal or retinal tissue) that causes altered immune response to self antigens. The most common causes today are surgery (particularly vitrectomies) followed by trauma that exposes uveal/retinal tissue.

Other examples:

- Phacoantigenic uveitis: Release of lens particles through ruptured lens capsule causes an autoimmune inflammatory response (there have been rare case reports of the fellow eye becoming involved as well).

- Autoimmune retinopathies such as CAR/MAR (cancer-associated retinopathy and melanoma-associated retinopathy): In short, a paraneoplastic syndrome where anti-bodies to cancer are presumed to cross react with retina self antigens.

-White dot syndromes (e.g. Birdshot chorioretinopathy, Serpiginous choroiditis, AZOOR): Though the etiologies of this group of diseases are not clear, autoimmunity is thought to play a role.

So yes, autoimmunity to normally immune privileged ocular tissue is important. There are many more examples that have been established or postulated. The brain (to include the retina and optic nerve) has a another list of autoimmune diseases (e.g. MS) that I won't get into with this post.