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Evidence and Consensus-Based Imaging Guidelines in Cytomegalovirus Retinitis: Multimodal Imaging in Uveitis (MUV)
Inês Leal1, Aniruddha Agarwal2, Meghan Berkenstock3
1Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; Ophthalmology Department, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.
Ophthalmology. Retina
|May 12, 2026
Summary
This study provides guidelines for using multimodal imaging in cytomegalovirus retinitis (CMVR). Color fundus photography (CFP) is key, with optical coherence tomography (OCT) and fluorescein angiography (FFA) aiding complication detection.
Area of Science:
- Ophthalmology
- Medical Imaging
Background:
- Cytomegalovirus retinitis (CMVR) is a significant cause of vision loss, particularly in immunocompromised individuals.
- Accurate diagnosis and monitoring of CMVR rely heavily on multimodal imaging techniques.
- Standardized guidelines are needed to optimize the use of various imaging modalities in CMVR management.
Purpose of the Study:
- To establish consensus-based guidelines for applying multimodal imaging in the diagnosis and management of cytomegalovirus retinitis (CMVR).
- To define key imaging biomarkers for disease activity, healing, and complications associated with CMVR.
- To recommend optimal imaging modalities for different stages of CMVR.
Main Methods:
- A systematic literature review was conducted.
- An expert committee of international uveitis and retina specialists utilized the nominal group technique (NGT) for consensus building.
- Participants reviewed cases and literature on CMVR using color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA).
Main Results:
- Color fundus photography (CFP) is considered essential for baseline assessment, treatment monitoring, and documenting lesion characteristics.
- Optical coherence tomography (OCT) aids in identifying retinal necrosis and complications like cystoid macular edema (CME).
- Fundus autofluorescence (FAF) helps delineate active lesions and identify healed areas, while FFA is useful for detecting arteriolar occlusion and leakage.
Conclusions:
- Clinical examination and CFP remain the primary tools for CMVR evaluation.
- OCT and FFA are valuable complementary modalities for detecting ocular complications, particularly in immune recovery uveitis.
- These guidelines offer a framework for selecting appropriate imaging in CMVR and support the development of standardized diagnostic criteria.
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