Evidence and Consensus-Based Imaging Guidelines in Ocular Toxoplasmosis Multimodal Imaging in Uveitis Task Force Report 14.

PURPOSE: To develop imaging and consensus-based guidelines for the application of multimodal imaging in ocular toxoplasmosis (OT).

DESIGN

International expert consensus study using the nominal group technique guided by systematic literature review.

PARTICIPANTS

International uveitis specialists and retina experts participating in the Multimodal Imaging in Uveitis (MUV) task force.

METHODS

A subgroup of experts reviewed the published literature on imaging in OT, along with complete multimodal imaging data sets from cases fulfilling the Standardization of Uveitis Nomenclature (SUN) criteria. Imaging modalities included color fundus photography, OCT, fundus autofluorescence (FAF), fundus fluorescein angiography, indocyanine green angiography (ICGA), and OCT angiography. Nominal group technique sessions were conducted to identify key imaging features of typical and atypical presentations of active and inactive OT across modalities and to define imaging findings associated with disease-related complications. Consensus-based imaging descriptors and practical imaging guidelines were developed through iterative discussion. The proposed guidelines were voted on by the MUV task force.

MAIN OUTCOME MEASURES: Identification of multimodal imaging features of active and inactive OT and development of imaging guidelines for diagnosis, activity assessment, and detection of complications.

RESULTS

The experts agreed that classic OT primarily remains a clinical diagnosis. Color fundus photography was considered sufficient for diagnosing typical active OT presenting as focal or paucifocal necrotizing retinochoroiditis. OCT provided important information on lesion depth, retinal and choroidal involvement, and vitreoretinal interface abnormalities and was particularly valuable in atypical presentations and for longitudinal disease monitoring. Fundus autofluorescence assisted in staging lesion evolution and identifying multiple evanescent white dot syndrome-like reactions. Fluorescein angiography and ICGA were not recommended for routine use but were suggested in selected cases to evaluate the presence and extent of complications. OCT angiography was considered sufficient for detecting choroidal neovascularization in most cases. Multimodal imaging was generally recommended for atypical OT and for assessment of complications.

CONCLUSIONS

The consensus-based imaging guidelines by MUV provide a standardized and pragmatic framework for the use of multimodal imaging in OT. Although the diagnosis in typical cases remains largely clinical, as outlined in the SUN classification, OCT and FAF are valuable for monitoring disease activity, and additional imaging modalities support the management of atypical presentations and complications.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.