Journal Article Ahead of print
PubMed: 42685929 DOI: 10.1016/j.oret.2026.08.026
Evidence and Consensus Based Imaging Guidelines in Ocular Toxoplasmosis. Multimodal imaging in Uveitis (MUV) Taskforce Report 14.
Ophthalmol Retina
Authors: Andrea Trinco, Alessandro Invernizzi, Alejandra de-la-Torre, Daniel Vasconcelos-Santos, Radgonde Amer, Ariel Schlaen, Manisha Agarwal, Jeanette Ossewaarde Von Norel, Aniruddha Agarwal, Sapna Gangaputra, Rupesh Agrawal, Douglas A Jabs, Marc D de Smet, Carlos Pavesio, Janet L Davis, Massimo Accorinti, David Sarraf, Vishali Gupta
Affiliations
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
- Departmento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel.
- Hospital Universitario Austral, Derqui-Pilar, Argentina.
- Dr Shroff's Charity Eye Hospital, New Delhi, India.
- UMC Utrecht, the Netherlands.
- Eye Department, Integrated Surgical Institute (ISI), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
- Programme for Ocular Inflammation & Infection Translational Research, Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Duke NUS Medical School, Singapore, Singapore; Ocular Infections and AntiMicrobials, Singapore Eye Research Institute, Singapore, Singapore.
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Microinvasive Ocular Surgery Institute, Lausanne, Switzerland; New York Eye and Ear Institute of Mt Sinai, Icahn School of Medicine, New York, USA; Department of Ophthalmology, Université libre de Bruxelles, Brussels, Belgium.
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK.
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
- IRCCS Fondazione G. B. Bietti (M.A.), Rome, Italy.
- Stein Eye Institute, University of California, Los Angeles, California, USA.
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
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 (NGT) guided by systematic literature review.
PARTICIPANTS
International uveitis specialists and retina experts participating in the Multimodal Imaging in Uveitis (MUV) taskforce.
METHODS
A subgroup of experts reviewed the published literature on imaging in OT, along with complete multimodal imaging datasets from cases fulfilling the Standardized Uveitis Nomenclature (SUN) criteria. Imaging modalities included color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA). NGT 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 taskforce.
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 remains primarily a clinical diagnosis. CFP 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. FAF assisted in staging lesion evolution and identifying MEWDS-like reactions. FA and ICGA were not recommended for routine use but suggested in selected cases to evaluate the presence and extent of complications. OCTA 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. While 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.
MeSH
Retinitis, Ophthalmology, Retina, Toxoplasmosis, Angiography, Toxoplasmosis, Ocular, Multimodal Imaging, Tomography, Optical Coherence, Diagnosis, Retinaldehyde, Uveitis