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

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 non-infectious 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.