Evidence and Consensus-based Imaging Guidelines in Birdshot Chorioretinopathy: Multimodal Imaging in Uveitis (MUV) Taskforce Report 8 - 13/09/25
Doi : 10.1016/j.ajo.2025.06.029
FRANCESCO PICHI 1, 2, ⁎ 
, ELISABETTA MISEROCCHI 3, 4, DILRAJ S. GREWAL 5, SUMIT SHARMA 6, ANTOINE P. BRÉZIN 7, BAHRAM BODAGHI 8, ANIRUDDHA AGARWAL 1, 2, DOUGLAS A. JABS 9, 10, AMANI FAWZI 11, DAVID SARRAF 12, VISHALI GUPTA 13, ⁎
, ELISABETTA MISEROCCHI 3, 4, DILRAJ S. GREWAL 5, SUMIT SHARMA 6, ANTOINE P. BRÉZIN 7, BAHRAM BODAGHI 8, ANIRUDDHA AGARWAL 1, 2, DOUGLAS A. JABS 9, 10, AMANI FAWZI 11, DAVID SARRAF 12, VISHALI GUPTA 13, ⁎ ON BEHALF OF THE MULTIMODAL IMAGING IN UVEITIS (MUV) TASKFORCE⁎
Alejandra de-la-Torre 14, Alejandro Fonollosa 15, Alessandro Invernizzi 16, 17, Amani Fawzi 18, Andrew Dick 19, 20, 21, 22, Aniruddha Agarwal 23, 24, Anita Agarwal 25, 26, Antoine Brezin 27, Ariel Schlaen 28, Bahram Bodaghi 29, Claudia Fabiani 30, David Sarraf 31, Debra A. Goldstein 32, Dilraj Grewal 33, Edmund Tsui 34, Elisabetta Miserocchi 35, 36, Ester Carreño 37, Francesco Pichi 23, Ilknur Tugal-Tutkun 38, Inês Leal 39, Janet L. Davis 40, Jeanette Ossewaarde-van Norel 41, Jennifer E. Thorne 42, Jessica G. Shantha 43, Jose S. Pulido 44, Justine Smith 45, Jyotirmay Biswas 46, K. Bailey Freund 47, 48, Kathryn Pepple 49, Lee M. Jampol 32, Luca Cimino 50, 51, Marc De Smet 52, Maria Vittoria Cicinelli 36, Marion R. Munk 53, Massimo Accorinti 54, Maura Di Nicola 55, Meghan Berkenstock 42, Michael Altaweel 56, 57, Phoebe Lin 58, Quan Dong Nguyen 59, Richard Spaide 47, Rupesh Agrawal 60, 61, 62, Sapna S. Gangaputra 63, Soon Phaik Chee 64, Srinivas Sadda 65, Sumit Sharma 66, Timothy M. Janetos 32, Vishali Gupta 67, Zohar Habot-Wilner 68
14 Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
15 Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
16 Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
17 Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia
18 Northwestern University Feinberg School of Medicine, Chicago, USA
19 University of Bristol, UK
20 Bristol Eye Hospital, UK
21 Institute of Ophthalmology, University College London, London, UK
22 National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
23 Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
24 Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
25 California Pacific Medical Center (CPMC), San Francisco, CA, USA
26 West Coast Retina, San Francisco, CA, USA
27 Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris Cité, 75014, Paris, France
28 Hospital Universitario Austral, Derqui-Pilar, Argentina
29 Department of Ophthalmology, IHU FOReSIGHT, Pitié-Salpêtrière Universtiy Hospital, Paris, France
30 Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Sienna, Italy
31 Stein Eye Institute, University of California, Los Angeles, California, USA
32 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
33 Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
34 Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
35 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
36 Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
37 Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
38 Department of Ophthalmology, Istanbul University, Istanbul, Turkey
39 Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
40 Department of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL, USA
41 University Medical Center Utrecht, Utrecht, the Netherlands
42 Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
43 Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, USA
44 Wills Eye Hospital, Thomas Jefferson University Philadelphia, PA
45 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
46 Uveitis & Ocular Pathology Department, Sankara Nethralaya, Chennai, India
47 Vitreous Retina Macula Consultants of New York, New York, USA
48 Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
49 Department of Ophthalmology, University of Washington, Seattle, USA
50 Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
51 Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
52 Micro Invasive Ocular Surgery Clinic, Lausanne, Switzerland
53 Augenarzt Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
54 IRCSS Fondazione Bietti, Rome, Italy
55 Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
56 Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA
57 McPherson Eye Research Institute, University of Wisconsin - Madison, WI, USA
58 Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, USA
59 Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA
60 National Healthcare Group Eye institute, Tan Tock Seng Hospital, Singapore
61 LKC School of Medicine, Nanyang Technological University, Singapore
62 Duke NUS Medical School, Singapore
63 Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
64 Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
65 Doheny Eye Institute, University of California – Los Angeles, Los Angeles, California, USA
66 Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, USA
67 Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
68 Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
1 From the Cleveland Clinic Abu Dhabi (F.P., A.A.), Eye Institute, Abu Dhabi, United Arab Emirates
2 Cleveland Clinic Lerner College of Medicine (F.P, A.A.), Case Western Reserve University, Cleveland, Ohio, USA
3 School of Medicine (E.M.), Vita-Salute San Raffaele University, Milan, Italy
4 Department of Ophthalmology (E.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy
5 Department of Ophthalmology (D.G.), Duke University School of Medicine, Durham, North Carolina, USA
6 Cleveland Clinic Foundation (S.S.), Cole Eye Institute, Cleveland, Ohio USA
7 Centre d’ophtalmologie de l’Assistance Publique – Hôpitaux de Paris (A.B.), Université Paris Cité, Paris, France
8 Department of Ophthalmology (B.B), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
9 Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology (D.J), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
10 Department of Ophthalmology (D.J.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
11 Department of Ophthalmology (A.F), Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
12 Stein Eye Institute (D.S), University of California, Los Angeles, California, USA
13 Advanced Eye Centre (V.G.), Postgraduate Institute of Medical Education and Research, Chandigarh, India
⁎Inquiries to Vishali Gupta, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaAdvanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia⁎⁎Inquiries to Francesco Pichi, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab EmiratesEye Institute, Cleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates
Résumé |
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.
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| This invited article was submitted as part of the Virtual Special Issue on Multimodal Imaging in Uveitis. |
© 2025
The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 278
P. 271-281 - octobre 2025 Retour au numéro
Article précédent
- Evidence and Consensus-Based Imaging Guidelines in Noninfectious Posterior Uveitis—Methodology of the Multimodal Imaging in Uveitis (MUV) Project Report 2
- Vishali Gupta, Janet L Davis, Sapna Gangaputra, Soon P Chee, Jennifer E Thorne, Rupesh Agrawal, Alessandro Invernizzi, Aniruddha Agarwal, Marc D de Smet, David Sarraf, Douglas A Jabs, Multimodal Imaging in Uveitis (MUV) Taskforce
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