Evidence and Consensus-Based Imaging Guidelines in Cytomegalovirus Retinitis
Year: 2026
Type: article
Abstract: PURPOSE: To develop imaging- and consensus-based guidelines for the application of multimodal imaging in cytomegalovirus retinitis (CMVR). DESIGN: Consensus agreement guided by a systematic literature review and expert committee deliberation using the nominal group technique (NGT). PARTICIPANTS: International uveitis specialists and retina experts participating in the Multimodal Imaging in Uveitis (MUV) task force. METHODS: Experts independently reviewed published literature and representative cases of active and inactive CMVR using color fundus photography (CFP), OCT, fundus autofluorescence, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography. Through structured NGT sessions, the committee developed consensus-based descriptors of active and inactive CMVR, key imaging biomarkers of disease activity, and characteristic complications. The proposed guidelines were subsequently voted on by the full MUV task force. MAIN OUTCOME MEASURES: Identification of reproducible multimodal imaging features of CMVR; definition of modality-specific biomarkers of disease activity and healing; consensus on the preferred imaging modalities for diagnosis, monitoring, and detection of complications. RESULTS: The experts agreed that CFP remains the most essential baseline and follow-up imaging modality for documenting the pattern, extent, and borders of the lesion, as well as the response to treatment. Ultra-widefield CFP was particularly valued for its ability to detect peripheral/satellite lesions and complications such as early retinal breaks. OCT is helpful in identifying inner retinal necrosis, characterizing retinal layer involvement, and development of complications such as cystoid macular edema (CME) and epiretinal membrane. Fundus autofluorescence assists in delineating the advancing edge of active retinitis and identifies healed lesions by their sharply demarcated hypoautofluorescent appearance. Fundus fluorescein angiography may help in identifying arteriolar occlusion, CME, and optic nerve head leakage. OCT angiography and ICGA have limited roles in diagnosing CMVR or assessing disease activity. CONCLUSIONS: Clinical examination/CFP remains the primary method for evaluating CMVR, in addition to other clinical tools such as diagnostic laboratory testing. OCT and FFA serve as complementary tools for detecting ocular complications, especially in immune-recovery uveitis. These consensus-based guidelines provide a framework for optimal imaging selection in CMVR and support future refinements of standardized diagnostic criteria. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Source: Ophthalmology Retina
Authors: Inês Leal, Aniruddha Agarwal, Meghan Berkenstock, Koh-Hei Sonoda, Emilio Dodds, John H. Kempen, Antoine P. Brézin, De-Kuang Hwang, Maria Vittoria Cicinelli, Alessandro Invernizzi, Sapna Gangaputra, Rupesh Agrawal, Douglas A. Jabs, Janet L. Davis, Jennifer E. Thorne, Justine R. Smith, David Sarraf, Vishali Gupta, Ahmed Sallam, Alejandra de-la-Torre, Alessandro Invernizzi, Andre Curi, Andrea Trinco, Aniruddha Agarwal, Anita Agarwal, Annabelle A. Okada, Antoine Brezin, Ariel Schlaen, Bahram Bodaghi, Carlos Pavesio, Daniel Vasconcelos-Santos, David Sarraf, Debra Goldstein, De-Kuang Hwang, Douglas A. Jabs, Edmund Tsui, Elisabetta Miserocchi, Emilio M. Dodds, Eric Crowell, Ester Carreño, Francesco Pichi, Heloisa Nascimento, Hiroshi Keino, Hiroshi Takase, Ilknur Tugal-Tutkun, Inês Leal, J. Fernando Arevalo, Janet L. Davis, Jeannette Ossewaarde-Von Norel, Jennifer E. Thorne, Jessica G. Shantha, John H. Kempen, Justine R. Smith, Justus Garweg, Jyotirmay Biswas, Kalpana Babu Murthy, Koh-Hei Sonoda, Luca Cimino, Lucia Sobrin, Manisha Agarwal, Marc D. de Smet, Maria Vittoria Cicinelli, Marion R. Munk, Mark Westcott, Masaru Takeuchi, Massimo Accorinti, Meghan K. Berkenstock, Michal Kramer, Moncef Khairallah, Mudit Tyagi, Oren Tomkins- Netzer, Padmamalini Mahendradas, Peizeng Yang, Peter McCluskey, Piergiorgio Neri, Pınar Çakar Özdal, Quan Dong Nguyen, Radgonde Amer, Reema Bansal, Rina La Distia Nora, Rupesh Agrawal, Ryoji Yanai, Samir Shoughy, Sapna Gangaputra, Sofia Androudi, Soumyava Basu, SriniVas R. Sadda, Sudarshan Sridharan, Timothy M. Janetos, Uday Pratap Singh Parmar, Uwe Pleyer, Vishali Gupta
Institutions: University of Lisbon, Centro Académico de Medicina de Lisboa, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Abu Dhabi, Case Western Reserve University, Johns Hopkins University, Johns Hopkins Medicine, Drexel University, Kyushu University, Massachusetts Eye and Ear Infirmary, Harvard University, Addis Ababa University, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, The University of Sydney, University of Milan, Luigi Sacco Hospital, Vanderbilt University Medical Center, Nanyang Technological University, Tan Tock Seng Hospital, Singapore Eye Research Institute, Duke-NUS Medical School, National Healthcare Group, University of Miami, University of Miami Health System, Flinders University, University of California, Los Angeles, Post Graduate Institute of Medical Education and Research
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,920
OpenAlex ID: W7161031332