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Biomedicines
Volume 13
Issue 7
10.3390/biomedicines13071521
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Case Report

Structural, Functional, and Cellular Analysis of a Case of Acute Zonal Occult Outer Retinopathy (AZOOR)

by
Mattia Iuliano
1,*,
Marco Lombardo
1,
Benedetto Falsini
2,
Jacopo Sebastiani
3,
Michele D’Ambrosio
3,
Francesco Martelli
4 and
Andrea Cusumano
1,3
1
Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
2
Macula & Genoma Foundation USA, New York, NY 10017, USA
3
Macula & Genoma Foundation, 00196 Rome, Italy
4
Department of Cardiovascular and Endocrine-Metabolic Diseases and Ageing, National Institute of Health, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
Biomedicines 2025, 13(7), 1521; https://doi.org/10.3390/biomedicines13071521 (registering DOI)
Submission received: 29 April 2025 / Revised: 15 June 2025 / Accepted: 18 June 2025 / Published: 21 June 2025
(This article belongs to the Special Issue Retinal Diseases: Pathogenetic, Diagnostic and Therapeutic Perspectives)
Versions Notes

Abstract

Background: Adaptive optics transscleral flood illumination (AO-TFI) enables in vivo, non-invasive, high-resolution imaging of retinal pigment epithelium (RPE) and photoreceptor (PR) cells, paving the way for a new potential characterization of retinal diseases. This study aimed to analyze RPE and PR cells in a case of acute zonal occult outer retinopathy (AZOOR) using AO-TFI. Methods: A patient affected by AZOOR underwent a comprehensive eye examination, perimetry, electroretinography (ERG), autofluorescence, and optical coherence tomography (OCT) during the acute phase (T0). After three years (T1), OCT angiography (OCTA) and AO-TFI were also performed. Voronoi analysis was utilized to quantify RPE and PR cells. Results: At T0, OCT revealed interruptions in the ellipsoid zone (EZ) of the right eye, while the structure of the left eye appeared normal. Perimetry and ERG were abnormal in both eyes. At T1, OCT indicated recovery of the EZ in the right eye, while thinning of the ONL persisted. Perimetry and mfERG values remained below normative limits. OCTA exhibited globally reduced vessel density in the inner retina of the right eye. AO-TFI demonstrated reduced PR density in affected areas despite preserved EZ, while RPE cell density appeared unaffected. Conclusion: AO-TFI enabled a detailed visualization and quantification of macular RPE and PR cells, providing valuable insights into the pathophysiology of AZOOR.
Keywords: adaptive optics transscleral flood illumination; AO-TFI; AZOOR; retinal pigment epithelium; photoreceptors; OCT; OCTA; dark-without-pressure adaptive optics transscleral flood illumination; AO-TFI; AZOOR; retinal pigment epithelium; photoreceptors; OCT; OCTA; dark-without-pressure

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MDPI and ACS Style

Iuliano, M.; Lombardo, M.; Falsini, B.; Sebastiani, J.; D’Ambrosio, M.; Martelli, F.; Cusumano, A. Structural, Functional, and Cellular Analysis of a Case of Acute Zonal Occult Outer Retinopathy (AZOOR). Biomedicines 2025, 13, 1521. https://doi.org/10.3390/biomedicines13071521

AMA Style

Iuliano M, Lombardo M, Falsini B, Sebastiani J, D’Ambrosio M, Martelli F, Cusumano A. Structural, Functional, and Cellular Analysis of a Case of Acute Zonal Occult Outer Retinopathy (AZOOR). Biomedicines. 2025; 13(7):1521. https://doi.org/10.3390/biomedicines13071521

Chicago/Turabian Style

Iuliano, Mattia, Marco Lombardo, Benedetto Falsini, Jacopo Sebastiani, Michele D’Ambrosio, Francesco Martelli, and Andrea Cusumano. 2025. "Structural, Functional, and Cellular Analysis of a Case of Acute Zonal Occult Outer Retinopathy (AZOOR)" Biomedicines 13, no. 7: 1521. https://doi.org/10.3390/biomedicines13071521

APA Style

Iuliano, M., Lombardo, M., Falsini, B., Sebastiani, J., D’Ambrosio, M., Martelli, F., & Cusumano, A. (2025). Structural, Functional, and Cellular Analysis of a Case of Acute Zonal Occult Outer Retinopathy (AZOOR). Biomedicines, 13(7), 1521. https://doi.org/10.3390/biomedicines13071521

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