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Primed Mycobacterial Uveitis (PMU) as a Model for Post-Infectious Uveitis

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Deconstructing White Dot Syndromes-Multimodal Imaging in Uveitis (MUV) Taskforce: Report 11.

Alessandro Invernizzi¹, Aniruddha Agarwal², Lee M Jampol³

¹From the Department of Biomedical and Clinical Science, Eye Clinic, Luigi Sacco Hospital (A.I., G.S.), University of Milan, Milan, Italy; Faculty of Medicine and Health, Save Sight Institute (A.I., P.M.), University of Sydney, Sydney, Australia.

American Journal of Ophthalmology

|May 18, 2026

Summary

The term "white dot syndromes" (WDS) is outdated for non-infectious posterior uveitis (NIPU). Advanced imaging reveals distinct features for each NIPU, suggesting different disease pathways and warranting disease-specific terminology.

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Area of Science:

Ophthalmology
Immunology
Medical Imaging

Background:

The term "white dot syndromes" (WDS) historically groups diverse non-infectious posterior uveitis (NIPU) entities based on funduscopic appearance.
The clinical relevance of the umbrella WDS terminology has been questioned due to potential heterogeneity among these conditions.

Purpose of the Study:

To critically examine the validity of the WDS construct in light of advanced retinal and choroidal imaging.
To evaluate whether current imaging technologies support a unified classification for these NIPU entities.

Main Methods:

Perspective review of literature on imaging and pathophysiology of NIPU.
Analysis of high-resolution OCT, OCT angiography (OCTA), and indocyanine green angiography (ICGA) findings.
Focus on six classically defined WDS entities: MEWDS, MFCPU, PIC, APMPPE, SC, and BSCR.

Main Results:

Multimodal imaging demonstrates distinct anatomic features and patterns of tissue involvement for each NIPU.
OCT/OCTA reveal specific damage patterns: photoreceptor/RPE injury (MEWDS), Bruch's membrane disruption (MFCPU/PIC), choriocapillaris ischemia (APMPPE/SC), and choroidal infiltration (BSCR).
ICGA differentiates choroidal perfusion, distinguishing vascular non-perfusion from other inflammatory damage.

Conclusions:

The WDS classification overlooks significant biological and prognostic differences among NIPU.
Imaging-based immunopathogenesis hypotheses suggest distinct pathways for each condition.
A paradigm shift towards disease-specific terminology is necessary for diagnostic precision and tailored management.