Egyptian consensus guidance for diagnosis of adults with non-infectious uveitis.

PURPOSE: To develop the Egyptian consensus diagnostic guidance for adult non-infectious uveitis (NIU), taking into consideration the regional epidemiologic patterns and healthcare resources.

METHODS

A modified three-round Delphi process was conducted from January to May 2024. A multidisciplinary committee of uveitis specialists, rheumatologists, and internists formulated 24 statements across eight diagnostic domains. Experts ranked statements using a 5-point Likert scale, with consensus defined as ≥ 75% agreement, a median score ≥ 4, and an interquartile range (IQR) ≤ 1.

RESULTS

A total of 26 experts participated in the first round, with 21 and 18 experts completing the second and third rounds, respectively (69.2% overall retention). The panel achieved consensus on all 24 diagnostic statements, emphasizing standardized examination and SUN-based inflammation grading. The panel endorsed a stepwise cost-effective systemic workup, mandating the exclusion of tuberculosis and syphilis in all adults and utilizing chest imaging (CXR/HRCT) as a baseline. MRI brain/orbit with gadolinium contrast was advised for selected cases. OCT and fluorescein angiography were recommended baseline imaging for posterior and panuveitis, while ocular sampling (aqueous or vitreous) was reserved for atypical or resistant cases. Disease description should follow SUN anatomical classification, and sight-threatening uveitis was defined by severe or prolonged inflammation that could permanently affect vision.

CONCLUSIONS

This multidisciplinary consensus provides a structured, evidence-driven framework for uveitis diagnosis tailored to the Egyptian clinical and epidemiological context. It aims to standardize local practice while aligning with international standards. Broader applicability requires local adaptation and validation.