New Insights into Imaging Patterns of Autoimmune Retinopathies: A Cluster-Based Update.

PURPOSE: To describe multimodal imaging (MMI) features in autoimmune retinopathies (AIR) and characterize distinct phenotypic clusters.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Ten patients diagnosed with AIR between November 2017 and August 2025 were evaluated at the Ocular Immunology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.

METHODS

Patients with paraneoplastic and nonparaneoplastic AIR underwent full-field electroretinography and MMI, including retinography, fundus autofluorescence (FAF), optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography. Qualitative pattern analysis was performed to identify recurring imaging features.

MAIN OUTCOME MEASURES: MMI characteristics of AIR.

RESULTS

Of 30 referred patients, 10 (14 eyes) met inclusion criteria (median age 42 years, range 28 to 65; 70% female; median follow-up 40 months). Three recurring imaging clusters were identified. One cluster showed features within the acute zonal occult outer retinopathy spectrum, including monozonal, bizonal, and trizonal configurations on FAF and OCT. A second cluster was characterized by predominant posterior pole photoreceptoritis with subtle FAF changes and diffuse outer retinal alterations on OCT. A third cluster showed unilateral, peripheral, retinitis pigmentosa-like degeneration with centripetal progression on FAF and mild capillary leakage on fluorescein angiography.

CONCLUSIONS

In this small case series, MMI revealed recurring phenotypic clusters in AIR that may help contextualize the heterogeneity of this condition. These observations are exploratory and hypothesis-generating, and warrant validation in larger, multicenter studies.