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Ocular manifestations of autoimmune polyendocrinopathy syndrome type 1

Couturier, Aude; Brézin, Antoine P.

Current Opinion in Ophthalmology: November 2016 - Volume 27 - Issue 6 - p 505–513
doi: 10.1097/ICU.0000000000000306
OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by Russell W. Read
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Purpose of review The ocular manifestations in autoimmune polyendocrinopathy syndrome type 1 (APS1) are frequent and have a poor prognosis. The phenotype of these APS1-associated ocular features have been recently characterized in molecularly confirmed patients with APS1.

Recent findings Keratopathy and retinopathy can be severe manifestations of APS1. Heterogeneous corneal involvement can be observed, ranging from minimal superficial punctate staining to severe stromal scarring with deep corneal neovascularization. This phenotypic heterogeneity, observed even in patients with identical AIRE mutations, is suggestive of a poor genotype–phenotype correlation. Similarly, in patients with retinopathy, peripheral pigmentary changes are noted in all cases, yet with heterogeneous severity, ranging from isolated patchy atrophy of the retinal pigment epithelium to a retinitis pigmentosa-like fundus. Macular atrophy with vision loss is found in most cases. The severity of ophthalmic findings is uncorrelated to that of systemic manifestations. An autoimmune origin with specific autoantibodies directed against corneal and/or retinal autoantigens is the main mechanism believed to be responsible for the ocular manifestations of APS1.

Summary Progressive keratopathy and/or retinopathy can lead to severe visual loss and pain in patients with APS1. Although no treatment has shown efficacy regarding the APS1-associated ocular manifestations, ophthalmologic examinations are recommended in these patients.

aDepartment of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7 – Sorbonne Paris Cité

bDepartment of Ophthalmology, Hôpital Cochin, AP-HP, Université Paris 5 – Paris Descartes, Paris, France

Correspondence to Antoine P. Brézin, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. Tel: +33 1 5841 2201; fax: +33 1 5841 2210; e-mail: antoine.brezin@aphp.fr

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