Systematic Review of Clinical Utility of Multimodal Imaging in Infectious Posterior Uveitis. Multimodal imaging in Uveitis (MUV) Taskforce Report 12.

TOPIC: To systematically evaluate the clinical utility of multimodal imaging (MMI) for the diagnosis, activity assessment, longitudinal monitoring, and detection of complications in the five most prevalent infectious posterior uveitides.

DESIGN

Systematic review and evidence-based quality appraisal.

PARTICIPANTS

Original research studies published between January 2018 and September 2025(primary cohort) and 2012-2017(supplemental cohort) evaluating MMI in ocular toxoplasmosis(TOXO), cytomegalovirus retinitis(CMVR), ocular tuberculosis(TB), syphilitic uveitis(SYPH), and acute retinal necrosis(ARN).

METHODS

MEDLINE, Embase, Cochrane, and Scopus were systematically searched. Independent reviewers extracted reported imaging findings and clinical utility statements for: color fundus photography (CFP), fundus autofluorescence (FAF), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA). Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and certainty of evidence was graded using a bespoke consensus-based scheme informed by GRADE principles.

MAIN OUTCOME MEASURES: (1)reported imaging findings for each entity and modality; and (2)statements of clinical utility for diagnosis, detection of disease activity, longitudinal monitoring, and detection of complications.

RESULTS

Among 122 included studies (82 primary and 40 supplemental), the primary studies contributed 5,522 individual patient examinations and 574 imaging statements, while the supplemental studies provided corroborating evidence. Overall, 366 clinical utility statements were identified across the four prespecified domains, including 30 statements supporting synergistic MMI strategies. CFP, including studies using ultra-widefield imaging, achieved high certainty for diagnosis and longitudinal monitoring in four of five entities (4/5, 80%), with moderate certainty in ARN. OCT achieved high certainty across all four clinical utility domains for four of five entities (4/5, 80%), with lower certainty in ARN owing to its limited evidence base. FFA achieved high certainty for complication detection in three of five entities. FAF achieved high certainty for disease activity in four of five entities. OCTA achieved high certainty in at least one domain for two of five entities, whereas ICGA achieved high certainty in at least one domain for only one of five entities.

CONCLUSIONS

Substantial evidence exists regarding the imaging findings and clinical utility of MMI in infectious posterior uveitis. Combined MMI enables integrated structural, vascular, and choroidal assessment beyond conventional clinical examination.