Paraneoplastic and nonparaneoplastic autoimmune retinopathy in a Chilean tertiary center: Case series and 12-month visual and structural outcomes

Objectives: To describe the clinical, structural, and functional characteristics of autoimmune retinopathy (AIR) in a cohort of Chilean patients, applying the six diagnostic domains proposed by the American Academy of Ophthalmology (AAO) 2025, and to evaluate the visual and anatomical outcomes at 12 months. Design and Setting: Retrospective case series, performed at Fundación Oftalmológica Los Andes, in Santiago, Chile, between 2005 and 2025. Materials and Methods: 25 eyes of 16 patients with a diagnosis of “probable or possible” AIR were included. Clinical variables and multimodal images were analyzed, evaluating best corrected visual acuity, wide field electroretinogram, Goldmann visual field, ellipsoid zone integrity, and medical treatment. Statistical analyses used: Nonparametric tests (Wilcoxon and Mann–Whitney U), Kaplan–Meier curves, and multivariate logistic regression models were used to explore predictors of relapse. Results: Sixty-eight percent of the patients were women, with a mean age of 54 ± 17 years. The majority had nonparaneoplastic AIR (96%) and seropositivity for antiretinal antibodies (75%). At 12 months, median acute viral myocarditis showed a slight but significant decrease (from 0.15 to 0.10 logarithm of the minimum angle of resolution; P = 0.015). Most eyes maintained functional stability, although progressive thinning of the outer nuclear layer (ONL) was observed. Relapse-free survival was 70%, with no differences according to immunosuppression. Conclusions: Early diagnosis and treatment with immunosuppressants seem to stabilize functional and structural parameters in AIR. Loss of ONL could precede visual changes. The usefulness of the AAO 2025 diagnostic model and the need for prospective studies with biomarkers and long-term imaging follow-up are highlighted.