Systematic Review of Clinical Utility of Multimodal Imaging in Noninfectious Posterior Uveitis: MUV Project Report 3

Topic: The clinical utility of multimodal imaging for diagnosis and management of non-infectious posterior uveitis. Relevance: Advances in multimodal imaging support amendment of the imaging strategies in the authoritative classification criteria published by the Standards of Uveitis Nomenclature II in 2021. Methods: Peer-reviewed electronic search in OVID MEDLINE, Embase, Cochrane, Scopus, last accessed August 6, 2024. Medical literature published from January 1, 2018, to July 12, 2024, for the primary analysis and from 2012-2017 inclusive for the secondary analysis. Independent reviewers extracted data using the Covidence Systematic Review Tool and assessed quality and bias with the Mixed Methods Assessment Tool, followed by a consensus process. Statements of imaging findings and clinical utility were tabulated. Main outcome measures were: (1) factual imaging findings for acute posterior multifocal placoid pigment epitheliopathy (APMPPE), birdshot chorioretinitis, multifocal choroiditis, punctate inner choroidopathy, multifocal evanescent white dot syndrome (MEWDS) and serpiginous choroiditis. Imaging modalities included color fundus (CFP), autofluorescence (FAF), OCT, fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT angiography; (2) subjective or objective statements of clinical utility for diagnosis, detection of activity, monitoring, or detection of complications. The level of evidence was evaluated using the GRADE process. Results: 70 studies from 2018-2024 met inclusion criteria and quality standards for study type. Combined with 63 foundational studies from 2012-2017, there were 292 specific imaging statements based on imaging examinations of 6537 patients in the primary analysis. There were 124 statements of clinical utility, with OCT or OCTA accounting for 66/124 (53%), plus an additional 29 statements of clinical utility for multimodal imaging (MMI). Evidence was ranked high for OCT on at least one outcome measure for each disease, followed by CFP, FAF, and FA in 4 of 5 diseases (80%), OCTA in 3 of 5 (60%), and ICGA in 1 of 5 (20%). Conclusion: Substantial information exists regarding the imaging findings in noninfectious posterior uveitis. Expert opinions generally favor the clinical utility of MMI. Additional research with efficient imaging strategies and objective outcome measures is warranted. Revision of current classification guidelines should be considered. Other: Protocol registration CRD42024576867 with PROSPERO (https://crd.york.ac.uk/prospero/).