TY - JOUR
T1 - Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7
AU - Carreño, Ester
AU - Maghsoudlou, Panayiotis
AU - Fonollosa, Alejandro
AU - Leal, Inês
AU - Schlaen, Ariel
AU - Abraham, Alan Roy
AU - Dick, Andrew D
AU - Agarwal, Aniruddha
AU - Gangaputra, Sapna
AU - Invernizzi, Alessandro
AU - Fawzi, Amani
AU - Miserocchi, Elisabetta
AU - Agrawal, Rupesh
AU - Jabs, Douglas A
AU - Sarraf, David
AU - Gupta, Vishali
AU - Ossewaarde-van Norel, Annette
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/10
Y1 - 2025/10
N2 - PURPOSE: To develop consensus-based guidelines on use and interpretation of multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy (APMPPE).DESIGN: Consensus agreement led by literature, and an expert committee using a nominal group technique (NGT).METHODS: The expert committee for APMPPE performed a thorough review of representative cases of APMPPE. The cases were used to develop guidelines for the diagnosis and follow-up of APMPPE using color fundus photography (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), and OCT angiography (OCTA). Structured NGT-based discussions were used to achieve consensus-based recommendations on imaging characteristics, disease activity, and complications, and subsequently were adopted by a vote of the entire taskforce.RESULTS: Diagnosis of active APMPPE is characterized by distinctive imaging findings on CFP, and hyper-reflectivity of the ellipsoid zone (EZ), external limiting membrane (ELM), and outer nuclear layer (ONL) on OCT. Choriocapillaris non-perfusion, detectable via early-phase FFA, ICGA or OCTA, is crucial. In the early stages of APMPPE, OCT findings may be unremarkable, making FFA, ICGA, and/or OCTA relevant for the diagnosis. Based on the imaging findings, APMPPE can be classified into 4 stages of activity: choroidal, chorioretinal, transitional, and resolved. Following diagnosis, OCT and OCTA can be used to monitor lesion activity and identify potential complications.CONCLUSIONS: MUV imaging criteria enable the identification of key diagnostic features for APMPPE, extending the Standardization of Uveitis Nomenclature (SUN) classification. These consensus-based guidelines provide a framework for evaluating disease activity and complications, enhancing diagnostic accuracy and guiding clinical management.
AB - PURPOSE: To develop consensus-based guidelines on use and interpretation of multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy (APMPPE).DESIGN: Consensus agreement led by literature, and an expert committee using a nominal group technique (NGT).METHODS: The expert committee for APMPPE performed a thorough review of representative cases of APMPPE. The cases were used to develop guidelines for the diagnosis and follow-up of APMPPE using color fundus photography (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), and OCT angiography (OCTA). Structured NGT-based discussions were used to achieve consensus-based recommendations on imaging characteristics, disease activity, and complications, and subsequently were adopted by a vote of the entire taskforce.RESULTS: Diagnosis of active APMPPE is characterized by distinctive imaging findings on CFP, and hyper-reflectivity of the ellipsoid zone (EZ), external limiting membrane (ELM), and outer nuclear layer (ONL) on OCT. Choriocapillaris non-perfusion, detectable via early-phase FFA, ICGA or OCTA, is crucial. In the early stages of APMPPE, OCT findings may be unremarkable, making FFA, ICGA, and/or OCTA relevant for the diagnosis. Based on the imaging findings, APMPPE can be classified into 4 stages of activity: choroidal, chorioretinal, transitional, and resolved. Following diagnosis, OCT and OCTA can be used to monitor lesion activity and identify potential complications.CONCLUSIONS: MUV imaging criteria enable the identification of key diagnostic features for APMPPE, extending the Standardization of Uveitis Nomenclature (SUN) classification. These consensus-based guidelines provide a framework for evaluating disease activity and complications, enhancing diagnostic accuracy and guiding clinical management.
KW - Acute Disease
KW - Coloring Agents/administration & dosage
KW - Consensus
KW - Fluorescein Angiography/methods
KW - Humans
KW - Indocyanine Green/administration & dosage
KW - Multimodal Imaging/standards
KW - Retinal Diseases/diagnosis
KW - Retinal Pigment Epithelium/pathology
KW - Tomography, Optical Coherence/methods
KW - Uveitis/diagnosis
U2 - 10.1016/j.ajo.2025.06.007
DO - 10.1016/j.ajo.2025.06.007
M3 - Article
C2 - 40484301
SN - 0002-9394
VL - 278
SP - 38
EP - 51
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
ER -