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

Area of Science:

• Ophthalmology
• Immunology
• Medical Imaging

Background:

• Autoimmune retinopathies (AIR) present a heterogeneous group of conditions affecting vision.
• Accurate diagnosis and classification of AIR are crucial for effective management.
• Multimodal imaging (MMI) offers a comprehensive approach to visualizing retinal pathology.

Purpose of the Study:

• To describe multimodal imaging (MMI) features in autoimmune retinopathies (AIR).
• To characterize distinct phenotypic clusters within AIR using MMI.
• To explore the utility of MMI in understanding the heterogeneity of AIR.

Main Methods:

• Retrospective observational case series of 10 patients diagnosed with AIR.
• Utilized a suite of MMI techniques 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 across paraneoplastic (pAIR) and non-paraneoplastic AIR (npAIR).

Main Results:

• Three recurring imaging clusters were identified in the 10 evaluated patients.
• Cluster 1 exhibited features within the acute zonal occult outer retinopathy spectrum (monozonal, bizonal, trizonal configurations on FAF and OCT).
• Cluster 2 showed predominant posterior pole photoreceptoritis with subtle FAF changes and diffuse outer retinal alterations on OCT.
• Cluster 3 presented as unilateral, peripheral, retinitis pigmentosa-like degeneration with centripetal progression on FAF and mild capillary leakage on FA.

Conclusions:

• Multimodal imaging identified recurring phenotypic clusters in autoimmune retinopathies.
• These imaging-based clusters may help contextualize the heterogeneity observed in AIR.
• The findings are exploratory and require validation in larger, multicenter studies.