Evidence and Consensus Based Guidelines for Imaging in Serpiginous Choroiditis - Multimodal imaging in Uveitis (MUV) Taskforce: Report 4

Purpose: To develop imaging and consensus-based guidelines for the application of multimodal imaging in serpiginous choroiditis (SC). Design: Consensus agreement guided by literature search, and an expert committee using a nominal group technique (NGT). Methods: An expert committee gathered cases of non-infectious SC based on pre-defined informatics-driven inclusion criteria. These criteria focused primarily on high-quality imaging, including color fundus photographs (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA). A structured NGT was applied to achieve consensus-based recommendations on imaging use for specific disease characteristics, biomarkers of activity, and complications. These recommendations were further voted upon by members of the full task force. Results: CFP and FAF are key imaging modalities for the diagnosis of SC. SC is characterized by amoeboid/serpentine choroiditis lesions on CFP, with hypo-autofluorescence in older inactive lesions and hyper-autofluorescence along the broad active edges. FAF is the most important tool for assessing disease activity. ICGA findings, particularly at the leading active edge, and OCT further aid in disease characterization. Early hypofluorescence of the active edge with uniform hyperfluorescent staining in the late phase of FFA are key features that help differentiate SC from other placoid chorioretinopathies. FFA, OCT and OCTA are useful in identifying underlying choroidal neovascularization, with OCTA being an important modality. Conclusions: MUV imaging criteria for SC extend the Standardization of Uveitis Nomenclature (SUN) classification, by providing guidelines for the use of multimodal imaging. These criteria also provide a framework for evaluation of disease activity and complications.