Evidence and Consensus-based Imaging Guidelines in Birdshot Chorioretinopathy: Multimodal Imaging in Uveitis (MUV) Taskforce Report 8
Francesco Pichi, Elisabetta Miserocchi, Dilraj S. Grewal, Sumit Sharma, Antoine P. Brézin, Bahram Bodaghi, Aniruddha Agarwal, Douglas A. Jabs, Amani A. Fawzi, David Sarraf, Vishali Gupta, Alejandra de-la-Torre, Alejandro Fonollosa, Alessandro Invernizzi, Amani Fawzi, Andrew Dick, Aniruddha Agarwal, Anita Agarwal, Antoine Brezin, Ariel Schlaen, Bahram Bodaghi, Claudia Fabiani, David Sarraf, Debra A. Goldstein, Dilraj Grewal, Edmund Tsui, Elisabetta Miserocchi, Ester Carreño, Francesco Pichi, Ilknur Tugal-Tutkun, Inês Leal, Janet L. Davis, Jeanette Ossewaarde-van Norel, Jennifer E. Thorne, Jessica G. Shantha, Jose S. Pulido, Justine Smith, Jyotirmay Biswas, K. Bailey Freund, Kathryn Pepple, Lee M. Jampol, Luca Cimino, Marc De Smet, Maria Vittoria Cicinelli, Marion R. Munk, Massimo Accorinti, Maura Di Nicola, Meghan Berkenstock, Michael Altaweel, Phoebe Lin, Quan Dong Nguyen, Richard Spaide, Rupesh Agrawal, Sapna S. Gangaputra, Soon Phaik Chee, Srinivas Sadda, Sumit Sharma, Timothy M. Janetos, Vishali Gupta, Zohar Habot-Wilner
Abstract
PURPOSE: To develop consensus-based imaging guidelines for diagnosing and monitoring birdshot chorioretinopathy (BSCR). DESIGN: Consensus-based approach guided by literature and an expert committee using a nominal group technique (NGT). METHODS: An expert committee of 5 international uveitis specialists reviewed 15 well-documented representative BSCR cases with comprehensive imaging data. Cases with active and inactive disease were included. Imaging, including color fundus photography (CFP), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA) were reviewed. Using a structured NGT approach, consensus-based recommendations were developed for specific disease characteristics, biomarkers of activity, and complications. The recommendations were voted upon by members of the full task force. RESULTS: For the diagnosis of BSCR, CFP, FFA, and ICGA were identified as the key imaging modalities. ICGA was identified as a key imaging modality for assessing the presence of choroidal lesions. FFA was deemed crucial for monitoring retinal vascular leakage and assessing the treatment response. OCT, while not essential for diagnosis, was valuable for detecting complications such as cystoid macular edema and retinal thinning. The committee did not reach a consensus on the role of FAF and OCTA for the diagnosis or monitoring of BSCR. CONCLUSIONS: The MUV consensus-based imaging guidelines for BSCR expand the Standardization of Uveitis Nomenclature (SUN) classification criteria by reaffirming the critical role of ICGA and providing a standardized guidelines for using other imaging modalities in the diagnosis and monitoring of BSCR. These guidelines are expected to facilitate monitoring of disease activity and complications using multimodal imaging.