Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis-Multimodal Imaging in Uveitis (MUV) Taskforce Report 5

Sapna Gangaputra; Aniruddha Agarwal; Jeannette Ossewaarde-van Norel; Edmund Tsui; Jennifer E Thorne; Alejandra de-la-Torre; Michael Altaweel; Jyotirmay Biswas; Srinivas Sadda; Alessandro Invernizzi; Rupesh Agrawal; Jessica G Shantha; Massimo Accorinti; Amani Fawzi; Douglas A Jabs; David Sarraf; Vishali Gupta; Multimodal Imaging in Uveitis (MUV) Task force

doi:10.1016/j.ajo.2025.04.018

Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis-Multimodal Imaging in Uveitis (MUV) Taskforce Report 5

Am J Ophthalmol. 2025 Apr 25:276:272-285. doi: 10.1016/j.ajo.2025.04.018. Online ahead of print.

Authors

Sapna Gangaputra¹, Aniruddha Agarwal², Jeannette Ossewaarde-van Norel³, Edmund Tsui⁴, Jennifer E Thorne⁵, Alejandra de-la-Torre⁶, Michael Altaweel⁷, Jyotirmay Biswas⁸, Srinivas Sadda⁹, Alessandro Invernizzi¹⁰, Rupesh Agrawal¹¹, Jessica G Shantha¹², Massimo Accorinti¹³, Amani Fawzi¹⁴, Douglas A Jabs¹⁵, David Sarraf⁴, Vishali Gupta¹⁶; Multimodal Imaging in Uveitis (MUV) Task force

Collaborators

Multimodal Imaging in Uveitis (MUV) Task force:
Alejandra de-la-Torre¹⁷, Alejandro Fonollosa¹⁸, Alessandro Invernizzi¹⁹, Amani Fawzi²⁰, Andrew Dick²¹, Aniruddha Agarwal²², Anita Agarwal²³, Antoine Brezin²⁴, Ariel Schlaen²⁵, Bahram Bodaghi²⁶, Claudia Fabiani²⁷, David Sarraf²⁸, Debra A Goldstein²⁹, Dilraj Grewal³⁰, Douglas A Jabs³¹, Edmund Tsui³², Elisabetta Miserocchi³³, Ester Carreño³⁴, Francesco Pichi³⁵, Ilknur Tugal-Tutkun³⁶, Inês Leal³⁷, Janet L Davis³⁸, Jeanette Ossewaarde-van Norel³⁹, Jennifer E Thorne⁴⁰, Jessica G Shantha⁴¹, Jose S Pulido⁴², Justine Smith⁴³, Jyotirmay Biswas⁴⁴, K Bailey Freund⁴⁵, Kathryn Pepple⁴⁶, Lee M Jampol²⁹, Luca Cimino⁴⁷, Marc De Smet⁴⁸, Maria Vittoria Cicinelli⁴⁹, Marion R Munk⁵⁰, Massimo Accorinti⁵¹, Maura Di Nicola⁵², Meghan Berkenstock⁴⁰, Michael Altaweel⁵³, Phoebe Lin⁵⁴, Quan Dong Nguyen⁵⁵, Richard Spaide⁵⁶, Rupesh Agrawal⁵⁷, Sapna S Gangaputra⁵⁸, Soon Phaik Chee⁵⁹, Srinivas Sadda⁶⁰, Sumit Sharma⁴³, Timothy M Janetos²⁹, Vishali Gupta⁶¹, Zohar Habot-Wilner⁶²

Affiliations

¹ Vanderbilt Eye Institute (S.G.), Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: sapna.gangaputra@vumc.org.
² Eye Institute (A.A.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (A.A.), Cleveland, Ohio, USA.
³ University Medical Center Utrecht (J.O.N.), Utrecht, the Netherlands.
⁴ Stein Eye Institute (E.T., D.S.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
⁵ Department of Ophthalmology (J.E.T., D.A.J.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; The Department of Epidemiology (J.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁶ Neuroscience Research Group (NEUROS) (A.D.T.), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
⁷ Department of Ophthalmology and Visual Sciences (M.A.), University of Wisconsin, Madison, Wisconsin, USA; McPherson Eye Research Institute (M.A.), University of Wisconsin, Madison, Wisconsin, USA.
⁸ Uveitis and Ocular Pathology Department (J.B.), Sankara Nethralaya, Chennai, India.
⁹ Doheny Eye Institute (S.S.), University of California, Los Angeles, Pasadena, California, USA.
¹⁰ Department of Biomedical and Clinical Science (A.I.), Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology (A.I.), Save Sight Institute, University of Sydney, Sydney, Australia.
¹¹ National Healthcare Group Eye institute (R.A.), Tan Tock Seng Hospital, Singapore; LKC School of Medicine (R.A.), Nanyang Technological University, Singapore; Duke NUS Medical School (R.A.), Singapore, Singapore; Ocular Infections and AntiMicrobials (R.A.), Singapore Eye Research Institute, Singapore, Singapore.
¹² Department of Ophthalmology (J.G.S.), Francis I. Proctor Foundation, University of California, San Francisco, USA.
¹³ IRCSS Fondazione G. B. Bietti (M.A.), Rome, Italy.
¹⁴ Northwestern University Feinberg School of Medicine (A.F.), Chicago, USA.
¹⁵ Department of Ophthalmology (J.E.T., D.A.J.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology (D.A.J.), Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹⁶ Advanced Eye Centre (V.G.), Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: vishalisara@gmail.com.
¹⁷ Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
¹⁸ Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain.
¹⁹ Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia.
²⁰ Northwestern University Feinberg School of Medicine, Chicago, USA.
²¹ University of Bristol, UK; Bristol Eye Hospital, UK; Institute of Ophthalmology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
²² Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
²³ California Pacific Medical Center (CPMC), San Francisco, CA, USA; West Coast Retina, San Francisco, CA, USA.
²⁴ Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris Cité, 75014, Paris, France.
²⁵ Hospital Universitario Austral, Derqui-Pilar, Argentina.
²⁶ Department of Ophthalmology, IHU FOReSIGHT, Pitié-Salpêtrière Universtiy Hospital, Paris, France.
²⁷ Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Sienna, Italy.
²⁸ Stein Eye Institute, University of California, Los Angeles, California, USA.
²⁹ Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA.
³⁰ Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
³¹ Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³² Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³³ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
³⁴ Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
³⁵ Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
³⁶ Department of Ophthalmology, Istanbul University, Istanbul, Turkey.
³⁷ Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal.
³⁸ Department of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL, USA.
³⁹ University Medical Center Utrecht, Utrecht, the Netherlands.
⁴⁰ Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴¹ Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, USA.
⁴² Wills Eye Hospital, Thomas Jefferson University Philadelphia, PA.
⁴³ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁴⁴ Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India.
⁴⁵ Vitreous Retina Macula Consultants of New York, New York, USA; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.
⁴⁶ Department of Ophthalmology, University of Washington, Seattle, USA.
⁴⁷ Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
⁴⁸ Micro Invasive Ocular Surgery Clinic, Lausanne, Switzerland.
⁴⁹ Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁵⁰ Augenarzt Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland.
⁵¹ IRCSS Fondazione G. B. Bietti, Rome, Italy.
⁵² Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
⁵³ Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA; McPherson Eye Research Institute, University of Wisconsin, Madison, WI, USA.
⁵⁴ Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, USA.
⁵⁵ Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA.
⁵⁶ Vitreous Retina Macula Consultants of New York, New York, USA.
⁵⁷ National Healthcare Group Eye institute, Tan Tock Seng Hospital, Singapore; LKC School of Medicine, Nanyang Technological University, Singapore; Duke NUS Medical School, Singapore.
⁵⁸ Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵⁹ Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore.
⁶⁰ Doheny Eye Institute, University of California, Los Angeles, Pasadena, California, USA.
⁶¹ Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
⁶² Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

PMID: 40288596
DOI: 10.1016/j.ajo.2025.04.018

Abstract

Purpose: To develop imaging and consensus-based guidelines on the application of multimodal imaging in noninfectious multifocal choroiditis and panuveitis (MFCPU) and punctate inner choroiditis (PIC).

Design: Consensus agreement guided by the review of literature and an expert committee using nominal group technique (NGT).

Methods: An expert committee applied a timed structured nominal group technique (NGT) to achieve consensus-based recommendations on specific disease characteristics, biomarkers of activity, and complications for MFCPU and PIC. Representative cases with noninfectious active and inactive MFCPU and PIC with color fundus photographs (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), OCT angiography (OCTA), indocyanine angiography (ICGA), and fundus autofluorescence images (FAF) were reviewed. These recommendations were voted upon by the entire task force.

Results: The experts agreed that lesions of MFCPU and PIC can be well characterized using CFP. OCT is the preferred modality for detecting active lesions. Both FAF and OCT are effective for monitoring disease recurrence. Late-phase ICGA is most valuable in recurrent disease when the lesions are not visible on FAF and CFP. While OCTA and ICGA can successfully identify lesions and complications such as choroidal neovascularization, no imaging biomarkers were found to reliably distinguish between active and inactive lesions on these two modalities.

Conclusions: Incorporating imaging findings, particularly OCT, into the Standardization of Uveitis Nomenclature (SUN) classification criteria for MFCPU and PIC enables more precise assessment of disease activity. These consensus-based guidelines provide a framework for selecting optimal imaging modalities for diagnosis, monitoring and identification of complications of MFCPU and PIC.