Serum antiretinal antibodies (ARA) in patients with choroidal melanoma – preliminary report

Introduction
To estimate serum antiretinal antibodies (ARA) in patients with choroidal melanoma after therapy in 3 months follow-up period.

Material and methods
24 patients at the age 37 – 72 years (mean: 57.8 years) with choroidal melanoma were examined. In all cases routine ophthalmic examination with A- and B-scan ultrasonography and fluorescein angiography were performed. In some subjects also indocyanine green angiography was performed. Ruthenium-106 plaques were used in 16 cases, in 5 cases treatment with Iodine-125 plaques was performed. Three patients underwent enucleation. In all cases ARA were determined in a serum dilution 1:10 by indirect immunofluorescence test on normal monkey retina as a substrate and FITC-labeled anti-human IgA, IgG, IgM serum (Euroimmun – Germany). ARA were scored before and within 3 months, after the therapy was performed.

Results
Before treatment ARA were present in 15 patients (62.5%) with choroidal melanoma in serum dilution 1:10. In a control group ARA were present in 3 cases (12.5%) in serum dilution 1:10. After therapy within 3 months follow-up period ARA occurred in serum of further 7 patients, all treated with Ruthenium-106 plaques. Fluorescence of outer retinal segments was present in 7 cases, while serum of remaining 15 patients demonstrated positive reaction within the whole tissue. Indirect immunofluorescence test on normal monkey retina revealed in 11 patients the presence of other autoantibodies; antinuclear and antinucleolar antibodies, reacting with nuclei of inner and outer nuclear layers of retina.

Conclusions
The presence of ARA in serum of patients with choroidal melanoma before therapy may be a result of autoimmune reaction against the tumor tissue. The detection of ARA in serum after plaque therapy may be associated with reaction due to tumor irradiation. The appearance of other serum autoantibodies in patients with choroidal melanoma may indicate at more advanced and generalized process.