ArticleFrontiers in neuroimaging2026
Distinct retinal oxygenation patterns in acute zonal occult outer retinopathy assessed by multimodal imaging.
Article in Frontiers in neuroimaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Acute zonal occult outer retinopathy (AZOOR) is a rare outer retinal disorder that may mimic inherited retinal dystrophy. This study revises a retrospective AZOOR case series by integrating retinal oximetry as a metabolic imaging biomarker and comparing the oximetry findings with retinitis pigmentosa (RP) and healthy control data. Methods: Seven consecutive patients diagnosed with AZOOR at HOCH Health Ostschweiz in St. Gallen, Switzerland were retrospectively reviewed. Multimodal assessment included best-corrected visual acuity, fundus examination, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), near-infrared reflectance (NIR-R), fluorescein angiography, visual field testing, multifocal electroretinography (mfERG), full-field electroretinography (ffERG), laboratory work-up, and magnetic resonance imaging. Retinal vessel oxygen saturation data (arteriolar: A-SO Results: The AZOOR cohort comprised seven patients (5 female, 2 male; median age 28 years, range 20-53). Six patients presented unilaterally; one patient had congenital aniridia bilaterally but AZOOR was clinically assigned to one presenting eye. Ellipsoid-zone disruption on SD-OCT was present in all affected eyes. MfERG demonstrated macular dysfunction in six of seven patients, whereas ffERG was abnormal in five of seven patients or showed normal full-field responses. Complete retinal oximetry data were available for eight eye/image measurements from four patients. Kruskal-Wallis testing across controls, RP, and AZOOR showed significant intergroup differences for A-SO Conclusion: Retinal oximetry added a metabolic dimension to multimodal AZOOR assessment. In this small exploratory cohort, AZOOR showed reduced arterial saturation and reduced arteriovenous oxygen difference compared with controls and RP, whereas venous saturation was not altered. This distinct metabolic AZOOR profile indicates reduced oxygen delivery resulting in altered oxygen use contrary to the known RP pattern of increased oxygen saturation and reduced oxygen use associated with photoreceptor degeneration. These findings should be interpreted cautiously but support further prospective evaluation of retinal oximetry as a complementary imaging biomarker in AZOOR and other outer retinal disorders.
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