Multimodal Imaging in Acute Idiopathic Maculopathy: Insights from Retro-Mode Scanning Laser Ophthalmoscopy

<b>Aim:</b> To describe the retro-mode scanning laser ophthalmoscopy (SLO) findings in acute idiopathic maculopathy and highlight its complementary role in disease assessment and follow-up. <b>Methods:</b> A single case was reviewed. <b>Results:</b> A 22-year-old woman presented with acute visual disturbances in her left eye 4 days following a flu-like illness. Multimodal imaging, including optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography, and retro-mode SLO, revealed characteristic features of acute idiopathic maculopathy, including subretinal hyperreflective material (SHRM), retinal pigment epithelium thickening, and choroidal inflammation. The patient was managed with a short tapering course of oral corticosteroids. Follow-up imaging demonstrated resolution of SHRM and subretinal fluid, restoration of the ellipsoid zone, and reduction in choroidal inflammation, with improvement in visual acuity from 6/18 to 6/6. Retro-mode SLO provided additional structural insights beyond conventional imaging, revealing persistent perifoveal granularity and subtle choroidal alterations despite apparent normalization on OCT. <b>Conclusions:</b> This is the first report to describe distinctive retro-mode SLO findings in acute idiopathic maculopathy, underscoring its potential utility as a complementary imaging modality for the diagnosis and longitudinal evaluation of this rare inflammatory condition.