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.
Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7 / Carreño, Ester; Maghsoudlou, Panayiotis; Fonollosa, Alejandro; Leal, Inês; Schlaen, Ariel; Abraham, Alan Roy; Dick, Andrew D.; Agarwal, Aniruddha; Gangaputra, Sapna; Invernizzi, Alessandro; Fawzi, Amani; Miserocchi, Elisabetta; Agrawal, Rupesh; Jabs, Douglas A.; Sarraf, David; Gupta, Vishali; de-la-Torre, Alejandra; Fonollosa, Alejandro; Invernizzi, Alessandro; Fawzi, Amani; Dick, Andrew ; Agarwal, Aniruddha; Agarwal, Anita; Brezin, Antoine; Schlaen, Ariel; Bodaghi, Bahram; Fabiani, Claudia; Sarraf, David; Goldstein, Debra A.; Grewal, Dilraj; Jabs, Douglas A.; Tsui, Edmund; Miserocchi, Elisabetta; Carreño, Ester; Pichi, Francesco; Tugal-Tutkun, Ilknur; Leal, Inês; Davis, Janet L.; Ossewaarde-van Norel, Jeannette; Thorne, Jennifer E.; Shantha, Jessica G.; Pulido, Jose S.; Smith, Justine R.; Biswas, Jyotirmay; Freund, K. Bailey; Pepple, Kathryn; Jampol, Lee M.; Cimino, Luca; De Smet, Marc; Cicinelli, Maria Vittoria; Munk, Marion R.; Accorinti, Massimo; Nicola, Maura Di; Berkenstock, Meghan; Altaweel, Michael; Lin, Phoebe; Nguyen, Quan Dong; Spaide, Richard; Agrawal, Rupesh; Gangaputra, Sapna S.; Chee, Soon Phaik; Sadda, Srinivas; Sharma, Sumit; Janetos, Timothy M.; Gupta, Vishali; Habot-Wilner, Zohar. - In: AMERICAN JOURNAL OF OPHTHALMOLOGY. - ISSN 0002-9394. - 278:(2025), pp. 38-51. [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
Miserocchi, Elisabetta;Miserocchi, Elisabetta;Cicinelli, Maria Vittoria;
2025-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
