Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7

doi:10.1016/j.ajo.2025.06.007

Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7

Título traducido de la contribución: Guías de imagen basadas en la evidencia y el consenso en la epiteliopatía pigmentaria placoidal multifocal posterior aguda (EPPMPA) - Informe 7 del Grupo de Trabajo sobre Imagen Multimodal en Uveítis (MUV).

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

9 Citas (Scopus)

Resumen

Objetivo
Desarrollar directrices basadas en el consenso sobre el uso e interpretación de imágenes multimodales en la epiteliopatía pigmentaria placoidal multifocal posterior aguda (APMPPE).
Diseño
Acuerdo por consenso basado en la literatura y un comité de expertos que utiliza la técnica de grupo nominal (TGN).
Métodos
El comité de expertos en APMPPE realizó una revisión exhaustiva de casos representativos de APMPPE. Estos casos se utilizaron para elaborar guías para el diagnóstico y seguimiento de APMPPE mediante retinografía a color (CFP), tomografía de coherencia óptica (OCT), angiografía fluoresceínica (FFA), angiografía con verde de indocianina (ICGA), autofluorescencia de fondo de ojo (FAF) y angiografía por OCT (OCTA). Se emplearon discusiones estructuradas basadas en el método NGT para alcanzar recomendaciones consensuadas sobre las características de imagen, la actividad de la enfermedad y las complicaciones, las cuales fueron posteriormente adoptadas por votación de todo el grupo de trabajo.
Resultados
El diagnóstico de APMPPE activa se caracteriza por hallazgos distintivos en la angiografía fluoresceínica (CFP) y por hiperreflectividad de la zona elipsoide (ZE), la membrana limitante externa (MLE) y la capa nuclear externa (CNE) en la tomografía de coherencia óptica (OCT). La no perfusión de la coriocapilaris, detectable mediante angiografía fluoresceínica (FFA), angiografía con verde de indocianina (ICGA) u OCTA en fase temprana, es crucial. En las etapas iniciales de la APMPPE, los hallazgos en la OCT pueden ser normales, por lo que la FFA, la ICGA y/o la OCTA son relevantes para el diagnóstico. Según los hallazgos de imagen, la APMPPE se clasifica en cuatro estadios de actividad: coroideo, coriorretiniano, transicional y resuelto. Tras el diagnóstico, la OCT y la OCTA permiten monitorizar la actividad de la lesión e identificar posibles complicaciones.
Conclusiones
Los criterios de imagen de la uveítis medial unilateral (MUV) permiten identificar características diagnósticas clave para la APMPPE, ampliando la clasificación de la Nomenclatura Estandarizada de la Uveítis (SUN). Estas guías basadas en el consenso proporcionan un marco para evaluar la actividad de la enfermedad y sus complicaciones, mejorando la precisión diagnóstica y orientando el manejo clínico.

Título traducido de la contribución	Guías de imagen basadas en la evidencia y el consenso en la epiteliopatía pigmentaria placoidal multifocal posterior aguda (EPPMPA) - Informe 7 del Grupo de Trabajo sobre Imagen Multimodal en Uveítis (MUV).
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	38-51
Número de páginas	14
Publicación	American Journal of Ophthalmology
Volumen	278
DOI	https://doi.org/10.1016/j.ajo.2025.06.007
Estado	Publicada - jun 6 2025
Publicado de forma externa	Sí

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ODS 3: Salud y bienestar

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@article{7ec82a1a121d456bb8370fb0e5e2aed8,

title = "Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7",

abstract = "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.",

author = "Ester Carre{\~n}o and Panayiotis Maghsoudlou and Alejandro Fonollosa and In{\^e}s Leal and Ariel Schlaen and Abraham, \{Alan Roy\} and Dick, \{Andrew D\} and Aniruddha Agarwal and Sapna Gangaputra and Alessandro Invernizzi and Amani Fawzi and Elisabetta Miserocchi and Rupesh Agrawal and Jabs, \{Douglas A\} and David Sarraf and Vishali Gupta",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jun,

day = "6",

doi = "10.1016/j.ajo.2025.06.007",

language = "English (US)",

volume = "278",

pages = "38--51",

journal = "American Journal of Ophthalmology",

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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

PY - 2025/6/6

Y1 - 2025/6/6

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.

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DO - 10.1016/j.ajo.2025.06.007

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