Pub Date : 2026-04-01Epub Date: 2026-01-10DOI: 10.1016/j.ajo.2026.01.011
Min Zhang , Peimin Lin , Tianhui Chen , Zexu Chen , Aizhu Miao , Ruohong Li , Yongxiang Jiang
Purposes
Define clinical ablation decentration and construct personalized areas for K measurements to improve the accuracy of intraocular lens (IOL) power calculation after myopic laser in situ keratomileusis (LASIK).
Design
Retrospective, observational case series.
Methods
Ablation areas were delineated on smoothed corneal topographies (Pentacam AXL). Personalized areas for K measurements were constructed as the overlap between the corneal ablation area and a given apex-centered circle. K values were calculated on these personalized areas using the ring or zone method. Ablation decentration was evaluated by (1) index P: the percentage of the personalized area in the corresponding circle, and (2) index D: the distance from its maximum inscribed circle center to the corneal apex. Their absolute predictive errors (AE) were compared with those of IOLMaster-reported K in 60 cataract eyes from 48 patients with prior LASIK.
Results
Ablation-guided K values derived from the 3.5 mm-diameter circle and the ring methods, namely K3.5ring, had the best predictive accuracy (Mean AE = 0.64D, Median AE = 0.47D). This method had better performance with smaller index P (ρ = -0.473, P = .006) and larger index D (ρ = 0.432, P = .014). Personalized areas with index P < 95.02% (P = .013) or index D ≥ 1.0975 mm (P = .007) showed greater accuracy improvements, and were defined as clinical ablation decentration.
Conclusions
This study developed a novel ablation-guided K measurement method for IOL calculation in eyes with clinically decentered myopic ablation. We also provide a ready-to-use tool (https://boluo-baba-ablation-guided-k-measurements.share.connect.posit.cloud) based on this method for clinical convenience.
{"title":"Ablation-Guided K Measurements Improve the Accuracy of IOL Power Calculation After Clinically Decentered Myopic LASIK","authors":"Min Zhang , Peimin Lin , Tianhui Chen , Zexu Chen , Aizhu Miao , Ruohong Li , Yongxiang Jiang","doi":"10.1016/j.ajo.2026.01.011","DOIUrl":"10.1016/j.ajo.2026.01.011","url":null,"abstract":"<div><h3>Purposes</h3><div>Define clinical ablation decentration and construct personalized areas for K measurements to improve the accuracy of intraocular lens (IOL) power calculation after myopic laser in situ keratomileusis (LASIK).</div></div><div><h3>Design</h3><div>Retrospective, observational case series.</div></div><div><h3>Methods</h3><div>Ablation areas were delineated on smoothed corneal topographies (Pentacam AXL). Personalized areas for K measurements were constructed as the overlap between the corneal ablation area and a given apex-centered circle. K values were calculated on these personalized areas using the ring or zone method. Ablation decentration was evaluated by (1) index P: the percentage of the personalized area in the corresponding circle, and (2) index D: the distance from its maximum inscribed circle center to the corneal apex. Their absolute predictive errors (AE) were compared with those of IOLMaster-reported K in 60 cataract eyes from 48 patients with prior LASIK.</div></div><div><h3>Results</h3><div>Ablation-guided K values derived from the 3.5 mm-diameter circle and the ring methods, namely K<sub>3.5ring</sub>, had the best predictive accuracy (Mean AE = 0.64D, Median AE = 0.47D). This method had better performance with smaller index P (ρ = -0.473, <em>P</em> = .006) and larger index D (ρ = 0.432, <em>P</em> = .014). Personalized areas with index P < 95.02% (<em>P</em> = .013) or index D ≥ 1.0975 mm (<em>P</em> = .007) showed greater accuracy improvements, and were defined as clinical ablation decentration.</div></div><div><h3>Conclusions</h3><div>This study developed a novel ablation-guided K measurement method for IOL calculation in eyes with clinically decentered myopic ablation. We also provide a ready-to-use tool (<span><span>https://boluo-baba-ablation-guided-k-measurements.share.connect.posit.cloud</span><svg><path></path></svg></span>) based on this method for clinical convenience.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 161-170"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-31DOI: 10.1016/j.ajo.2025.12.024
Paulo J.M. Bispo , Nicole L. Belanger , Renee Liu , Eduardo Ferracioli-Oda , Tatiana Tanaka , Joyce Hisae Yamamoto , Lucia Sobrin
Purpose
Current diagnostic workup for infectious uveitis relies on the use of various immunoassays and polymerase chain reaction (PCR) tests on ocular fluids that are time consuming and not comprehensive, requiring large sample volumes to probe for all causes. To streamline the diagnostic process, improve turnaround time, and target inclusivity, we developed a highly multiplexed pan-ocular-pathogen panel (OcuPan) that can be used for broad-range pathogen detection in only 1 assay, with PCR-level sensitivity and in a timely fashion (12 hours). Here, we assessed the clinical usefulness and performance of this innovative assay as a novel tool for rapid and accurate laboratory diagnosis of infectious uveitis.
Design
Laboratory evaluation of a novel diagnostic test and technology
Participants and Controls
A total of 109 patients from 2 centers were included, including 78 infectious uveitis cases and 31 controls.
Methods
Intraocular samples (n = 108 from patients and 43 from controls) were processed by PCR and the OcuPan diagnostic assay that detects 46 ocular pathogens plus 2 resistance/virulence markers.
Main Outcome Measures
Clinical sensitivity and specificity, quantification capabilities, and agreement between PCR and the OcuPan assay.
Results
The clinical sensitivity and specificity of the OcuPan assay were 50.9% (95% CI, 41.3-60.5) and 100% (95% CI 89.7%-100%), respectively. Sensitivity varied according to the sample matrix tested, with undiluted vitreous having the highest positivity rates (72.4%, 95% CI 55.1-89.7), followed by dilute vitreous (53.3%, 95% CI 34.4-72.3) and aqueous (36.7%, 95% CI 22.7-50.7). There was excellent overall agreement (93.5%) between the OcuPan assay and PCR (kappa of 0.870 ± 0.047; P < .001) with positive (PPA) and negative (NPA) percentage agreements >92% for all targets. PPA was 100% for herpesviruses and Treponema pallidum, whereas the NPA values ranged from 96.6% to 100% for these pathogens. For Toxoplasma gondii, the PPA was 75% and NPA 100%. We also found significant correlation (Spearman ρ = –0.7506, P < .0001) between the quantitative metric for the OcuPan assay and the real-time PCR cycle threshold values.
Conclusions
The OcuPan assay offers an all-in-one highly multiplexed detection system for rapid, comprehensive, quantitative, and accurate diagnosis of infectious uveitis.
{"title":"Clinical Assessment of a Highly Multiplexed Panel Assay for the Diagnosis of Infectious Uveitis","authors":"Paulo J.M. Bispo , Nicole L. Belanger , Renee Liu , Eduardo Ferracioli-Oda , Tatiana Tanaka , Joyce Hisae Yamamoto , Lucia Sobrin","doi":"10.1016/j.ajo.2025.12.024","DOIUrl":"10.1016/j.ajo.2025.12.024","url":null,"abstract":"<div><h3>Purpose</h3><div>Current diagnostic workup for infectious uveitis relies on the use of various immunoassays and polymerase chain reaction (PCR) tests on ocular fluids that are time consuming and not comprehensive, requiring large sample volumes to probe for all causes. To streamline the diagnostic process, improve turnaround time, and target inclusivity, we developed a highly multiplexed pan-ocular-pathogen panel (OcuPan) that can be used for broad-range pathogen detection in only 1 assay, with PCR-level sensitivity and in a timely fashion (12 hours). Here, we assessed the clinical usefulness and performance of this innovative assay as a novel tool for rapid and accurate laboratory diagnosis of infectious uveitis.</div></div><div><h3>Design</h3><div>Laboratory evaluation of a novel diagnostic test and technology</div></div><div><h3>Participants and Controls</h3><div>A total of 109 patients from 2 centers were included, including 78 infectious uveitis cases and 31 controls.</div></div><div><h3>Methods</h3><div>Intraocular samples (n = 108 from patients and 43 from controls) were processed by PCR and the OcuPan diagnostic assay that detects 46 ocular pathogens plus 2 resistance/virulence markers.</div></div><div><h3>Main Outcome Measures</h3><div>Clinical sensitivity and specificity, quantification capabilities, and agreement between PCR and the OcuPan assay.</div></div><div><h3>Results</h3><div>The clinical sensitivity and specificity of the OcuPan assay were 50.9% (95% CI, 41.3-60.5) and 100% (95% CI 89.7%-100%), respectively. Sensitivity varied according to the sample matrix tested, with undiluted vitreous having the highest positivity rates (72.4%, 95% CI 55.1-89.7), followed by dilute vitreous (53.3%, 95% CI 34.4-72.3) and aqueous (36.7%, 95% CI 22.7-50.7). There was excellent overall agreement (93.5%) between the OcuPan assay and PCR (kappa of 0.870 ± 0.047; <em>P</em> < .001) with positive (PPA) and negative (NPA) percentage agreements >92% for all targets. PPA was 100% for herpesviruses and <em>Treponema pallidum</em>, whereas the NPA values ranged from 96.6% to 100% for these pathogens. For <em>Toxoplasma gondii</em>, the PPA was 75% and NPA 100%. We also found significant correlation (Spearman ρ = –0.7506, <em>P</em> < .0001) between the quantitative metric for the OcuPan assay and the real-time PCR cycle threshold values.</div></div><div><h3>Conclusions</h3><div>The OcuPan assay offers an all-in-one highly multiplexed detection system for rapid, comprehensive, quantitative, and accurate diagnosis of infectious uveitis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 15-29"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-10DOI: 10.1016/j.ajo.2026.01.004
Nitesh Mohan , Sunil K. Srivastava , Matthew J. Schulgit , Rula A. Hajj-Ali , David C. Kaelber , Sumit Sharma
OBJECTIVE
To evaluate the association between immune-mediated inflammatory diseases (IMIDs) and uveitis.
DESIGN
Retrospective cohort and case-control study using electronic health record data.
METHODS
The study included patients diagnosed with uveitis and/or one of the following 12 IMIDs: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, scleroderma, inflammatory bowel disease (IBD), multiple sclerosis (MS), ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis (JIA), and giant cell arteritis (GCA), anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis, and other systemic vasculitis. Controls were patients without prior uveitis diagnosis or any IMIDs. The risk of developing uveitis in patients with each IMID, the odds of prior IMID diagnoses among patients with uveitis, and the risk of developing an IMID following a uveitis diagnosis were calculated. The main outcome measures were the risk ratio (RR) and odds ratio (OR) estimates with 95% confidence intervals for associations between IMIDs and uveitis.
RESULTS
Patients with all 12 IMIDs had a significantly increased risk of developing uveitis. The highest risks were observed in ankylosing spondylitis (RR = 7.71, 95% CI = 5.84-10.19), JIA (RR = 5.13, 95% CI = 3.51-7.49), and systemic vasculitis (RR = 4.61, 95% CI = 3.73-5.69). Increased risk was also found in sarcoidosis (RR = 3.67, 95% CI = 3.02-4.47), GCA (RR = 3.24, 95% CI = 2.58-4.07), and ANCA vasculitis (RR = 3.18, 95% CI = 1.84-5.48). In addition, in patients with uveitis, both the odds of a prior IMID diagnosis and the risk of a future IMID diagnosis were significantly increased for all 12 IMIDs.
CONCLUSIONS
IMIDs are strongly associated with uveitis, with significant bidirectional risk. Patients with uveitis should be monitored for potential IMID development, and those with IMIDs should undergo ophthalmologic evaluation when appropriate.
{"title":"Exploring the Association Between Autoimmune and Inflammatory Diseases and Uveitis","authors":"Nitesh Mohan , Sunil K. Srivastava , Matthew J. Schulgit , Rula A. Hajj-Ali , David C. Kaelber , Sumit Sharma","doi":"10.1016/j.ajo.2026.01.004","DOIUrl":"10.1016/j.ajo.2026.01.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To evaluate the association between immune-mediated inflammatory diseases (IMIDs) and uveitis.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort and case-control study using electronic health record data.</div></div><div><h3>METHODS</h3><div>The study included patients diagnosed with uveitis and/or one of the following 12 IMIDs: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, scleroderma, inflammatory bowel disease (IBD), multiple sclerosis (MS), ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis (JIA), and giant cell arteritis (GCA), anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis, and other systemic vasculitis. Controls were patients without prior uveitis diagnosis or any IMIDs. The risk of developing uveitis in patients with each IMID, the odds of prior IMID diagnoses among patients with uveitis, and the risk of developing an IMID following a uveitis diagnosis were calculated. The main outcome measures were the risk ratio (RR) and odds ratio (OR) estimates with 95% confidence intervals for associations between IMIDs and uveitis.</div></div><div><h3>RESULTS</h3><div>Patients with all 12 IMIDs had a significantly increased risk of developing uveitis. The highest risks were observed in ankylosing spondylitis (RR = 7.71, 95% CI = 5.84-10.19), JIA (RR = 5.13, 95% CI = 3.51-7.49), and systemic vasculitis (RR = 4.61, 95% CI = 3.73-5.69). Increased risk was also found in sarcoidosis (RR = 3.67, 95% CI = 3.02-4.47), GCA (RR = 3.24, 95% CI = 2.58-4.07), and ANCA vasculitis (RR = 3.18, 95% CI = 1.84-5.48). In addition, in patients with uveitis, both the odds of a prior IMID diagnosis and the risk of a future IMID diagnosis were significantly increased for all 12 IMIDs.</div></div><div><h3>CONCLUSIONS</h3><div>IMIDs are strongly associated with uveitis, with significant bidirectional risk. Patients with uveitis should be monitored for potential IMID development, and those with IMIDs should undergo ophthalmologic evaluation when appropriate.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 101-109"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-24DOI: 10.1016/j.ajo.2026.03.020
Lukas Goerdt, Vanessa Basten, Jan H. Terheyden, Hannah Dunbar, Ulrich Luhmann, Nadia Zakaria, Sergio Leal, Klaus-Peter Moll, Stephen Poor, Adnan Tufail, Matthias Schmid, Robert P. Finger, Steffen Schmitz-Valckenberg, Frank G. Holz, Marlene Saßmannshausen
{"title":"Hyperreflective foci contiguous with the RPE associate with visual function in aging, early and intermediate AMD: MACUSTAR study report","authors":"Lukas Goerdt, Vanessa Basten, Jan H. Terheyden, Hannah Dunbar, Ulrich Luhmann, Nadia Zakaria, Sergio Leal, Klaus-Peter Moll, Stephen Poor, Adnan Tufail, Matthias Schmid, Robert P. Finger, Steffen Schmitz-Valckenberg, Frank G. Holz, Marlene Saßmannshausen","doi":"10.1016/j.ajo.2026.03.020","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.03.020","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"17 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-23DOI: 10.1016/j.ajo.2026.03.021
Anika Shah, Sean T. Berkowitz, Edmund Tsui, John A. Gonzales, Eric L. Crowell, Sapna Gangaputra
{"title":"Forecasting the Workforce of Uveitis Specialists","authors":"Anika Shah, Sean T. Berkowitz, Edmund Tsui, John A. Gonzales, Eric L. Crowell, Sapna Gangaputra","doi":"10.1016/j.ajo.2026.03.021","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.03.021","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"92 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo evaluate the contribution and application of orbital fat-to-muscle ratio (FMR) in Thyroid Eye Disease related restrictive strabismus.DESIGNRetrospective cross-sectional study.SUBJECTS, PARTICIPANTSAdult patients (≥18 years) with a confirmed diagnosis of TED evaluated at a tertiary referral thyroid eye disease clinic between 2017 and 2025 who had high-resolution orbital CT imaging available for quantitative analysis.METHODSOrbital CT scans were analyzed using three-dimensional (3D) volumetric segmentation to quantify orbital fat and extraocular muscle (EOM) volumes. The FMR was calculated for each orbit. A simplified single-slice two-dimensional (2D) FMR was also measured for comparison. Clinical data included presence and magnitude of strabismus, restrictive ocular motility, Clinical Activity Score (CAS), thyroid-stimulating immunoglobulin (TSI) levels, and surgical history. Associations were assessed using correlation analyses, multivariable logistic regression, intraclass correlation coefficients (ICC), and receiver operating characteristic (ROC) analysis.MAIN OUTCOME MEASURESAssociation of FMR with TED factors associated with disease severity, restrictive ocular motility and strabismus presence.RESULTSOf 579 screened patients, 197 met inclusion criteria (mean age 54.9 ± 16.3 years; 69.7% female). Restrictive ocular motility was present in 39.1% and was associated with significantly lower FMR compared with nonrestrictive disease (0.69 ± 0.36 vs. 0.91 ± 0.42; p < 0.001). Strabismus angle correlated inversely with FMR (r = -0.169; p = 0.030), as did the number of EOMs operated during strabismus surgery (r = -0.160; p = 0.027). FMR was negatively correlated with CAS (r = -0.186; p = 0.010) and TSI (r = -0.188; p = 0.047). In multivariable analysis, lower FMR remained an independent predictor of restrictive motility. An FMR cutoff of 0.66 best discriminated the presence of strabismus (sensitivity 0.59; specificity 0.72). Agreement between 2D and 3D measurements was good (ICC = 0.77).CONCLUSIONSQuantitative FMR derived from CT segmentation is a clinically relevant imaging biomarker in TED that reflects a continuous spectrum of muscle and fat involvement. Lower FMR identifies patients at increased risk for restrictive motility, strabismus, and inflammatory activity. Three-dimensional FMR provides superior anatomical and clinical relevance compared with 2D measurements and may enhance risk stratification and longitudinal assessment in TED.
{"title":"Quantifying Orbital Segmentation in Thyroid Eye Disease- Fat to Muscle Ratio correlates with Restrictive Strabismus.","authors":"Sharon Armarnik,Daniel Hilewitz,Michael Kinori,Noa Barnea,Mor Lederer,Orr Bachar,Ofira Zloto,Guy Ben Simon,Daphna Landau-Prat,Limor Haviv,Dina Orkin,Ayelet Priel","doi":"10.1016/j.ajo.2026.03.018","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.03.018","url":null,"abstract":"OBJECTIVETo evaluate the contribution and application of orbital fat-to-muscle ratio (FMR) in Thyroid Eye Disease related restrictive strabismus.DESIGNRetrospective cross-sectional study.SUBJECTS, PARTICIPANTSAdult patients (≥18 years) with a confirmed diagnosis of TED evaluated at a tertiary referral thyroid eye disease clinic between 2017 and 2025 who had high-resolution orbital CT imaging available for quantitative analysis.METHODSOrbital CT scans were analyzed using three-dimensional (3D) volumetric segmentation to quantify orbital fat and extraocular muscle (EOM) volumes. The FMR was calculated for each orbit. A simplified single-slice two-dimensional (2D) FMR was also measured for comparison. Clinical data included presence and magnitude of strabismus, restrictive ocular motility, Clinical Activity Score (CAS), thyroid-stimulating immunoglobulin (TSI) levels, and surgical history. Associations were assessed using correlation analyses, multivariable logistic regression, intraclass correlation coefficients (ICC), and receiver operating characteristic (ROC) analysis.MAIN OUTCOME MEASURESAssociation of FMR with TED factors associated with disease severity, restrictive ocular motility and strabismus presence.RESULTSOf 579 screened patients, 197 met inclusion criteria (mean age 54.9 ± 16.3 years; 69.7% female). Restrictive ocular motility was present in 39.1% and was associated with significantly lower FMR compared with nonrestrictive disease (0.69 ± 0.36 vs. 0.91 ± 0.42; p < 0.001). Strabismus angle correlated inversely with FMR (r = -0.169; p = 0.030), as did the number of EOMs operated during strabismus surgery (r = -0.160; p = 0.027). FMR was negatively correlated with CAS (r = -0.186; p = 0.010) and TSI (r = -0.188; p = 0.047). In multivariable analysis, lower FMR remained an independent predictor of restrictive motility. An FMR cutoff of 0.66 best discriminated the presence of strabismus (sensitivity 0.59; specificity 0.72). Agreement between 2D and 3D measurements was good (ICC = 0.77).CONCLUSIONSQuantitative FMR derived from CT segmentation is a clinically relevant imaging biomarker in TED that reflects a continuous spectrum of muscle and fat involvement. Lower FMR identifies patients at increased risk for restrictive motility, strabismus, and inflammatory activity. Three-dimensional FMR provides superior anatomical and clinical relevance compared with 2D measurements and may enhance risk stratification and longitudinal assessment in TED.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"12 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1016/j.ajo.2026.03.015
Lorenzo Bianco,Alessandro Berni,Sebastiano Del Fabbro,Alessio Antropoli,Francesco Bandello,Maria Vittoria Cicinelli,Elisabetta Miserocchi
Non-infectious posterior and panuveitides (NIPUs) comprise a heterogeneous group of inflammatory disorders of the outer retina and choroid, historically referred to as "white dot syndromes." Recent consensus efforts by the Multimodal Imaging in Uveitis (MUV) Task Force have established standardized diagnostic criteria for the major NIPUs, including multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis and panuveitis/punctate inner choroiditis (MFCPU/PIC), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis, and birdshot chorioretinopathy (BSCR). Nevertheless, a substantial proportion of cases deviate from classical presentations and fall into diagnostic "grey zones", blurring boundaries between diseases entities and complicating both differential diagnosis and management. This review aims to describe the broad spectrum of atypical, variant, and secondary forms of NIPUs as well as masquerade syndromes. Atypical MEWDS includes bilateral presentations or complicated courses, while MFCPU/PIC with outer retinal atrophy emerges as a notable entity with unclear therapeutic implications. Inflammatory reactions resembling both MEWDS and MFCPU/PIC may also occur as secondary phenomena, triggered by other chorioretinal disorders, most notably inherited retinal diseases (IRDs). Placoid chorioretinopathies, including APMPPE, persistent placoid maculopathy, serpiginous choroiditis, and relentless placoid chorioretinitis, are often distinguished only a posteriori based on disease course, but likely represent a continuum of disorders unified by choroidal ischemia. Atypical presentations of BSCR may feature extensive outer retinal damage, mimicking IRDs. Equally important is the consideration of masquerade syndromes in all suspected cases of NIPUs, as they can present with similar features yet require entirely different treatments. Infectious masquerades include tuberculosis-associated serpiginous-like choroiditis, acute syphilitic posterior placoid chorioretinopathy, and West Nile virus chorioretinitis, whereas vitreoretinal lymphoma is the most frequent neoplastic masquerade. In conclusion, integrating clinical context with high-quality multimodal imaging remains essential to navigate the jungle of differential diagnosis in NIPUs, while future studies should aim to link imaging phenotypes with immune and molecular biomarkers to refine classification and guide targeted therapies.
{"title":"NON-INFECTIOUS POSTERIOR UVEITIDES - Atypicals, Variants, and Masquerades: the jungle of differential diagnosis.","authors":"Lorenzo Bianco,Alessandro Berni,Sebastiano Del Fabbro,Alessio Antropoli,Francesco Bandello,Maria Vittoria Cicinelli,Elisabetta Miserocchi","doi":"10.1016/j.ajo.2026.03.015","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.03.015","url":null,"abstract":"Non-infectious posterior and panuveitides (NIPUs) comprise a heterogeneous group of inflammatory disorders of the outer retina and choroid, historically referred to as \"white dot syndromes.\" Recent consensus efforts by the Multimodal Imaging in Uveitis (MUV) Task Force have established standardized diagnostic criteria for the major NIPUs, including multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis and panuveitis/punctate inner choroiditis (MFCPU/PIC), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis, and birdshot chorioretinopathy (BSCR). Nevertheless, a substantial proportion of cases deviate from classical presentations and fall into diagnostic \"grey zones\", blurring boundaries between diseases entities and complicating both differential diagnosis and management. This review aims to describe the broad spectrum of atypical, variant, and secondary forms of NIPUs as well as masquerade syndromes. Atypical MEWDS includes bilateral presentations or complicated courses, while MFCPU/PIC with outer retinal atrophy emerges as a notable entity with unclear therapeutic implications. Inflammatory reactions resembling both MEWDS and MFCPU/PIC may also occur as secondary phenomena, triggered by other chorioretinal disorders, most notably inherited retinal diseases (IRDs). Placoid chorioretinopathies, including APMPPE, persistent placoid maculopathy, serpiginous choroiditis, and relentless placoid chorioretinitis, are often distinguished only a posteriori based on disease course, but likely represent a continuum of disorders unified by choroidal ischemia. Atypical presentations of BSCR may feature extensive outer retinal damage, mimicking IRDs. Equally important is the consideration of masquerade syndromes in all suspected cases of NIPUs, as they can present with similar features yet require entirely different treatments. Infectious masquerades include tuberculosis-associated serpiginous-like choroiditis, acute syphilitic posterior placoid chorioretinopathy, and West Nile virus chorioretinitis, whereas vitreoretinal lymphoma is the most frequent neoplastic masquerade. In conclusion, integrating clinical context with high-quality multimodal imaging remains essential to navigate the jungle of differential diagnosis in NIPUs, while future studies should aim to link imaging phenotypes with immune and molecular biomarkers to refine classification and guide targeted therapies.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"44 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1016/j.ajo.2026.03.011
Aniruddha Agarwal,Prithvi Ramtohul,Alessandro Invernizzi,Sapna Gangaputra,Edmund Tsui,Annabelle A Okada,Jennifer E Thorne,Marc D de Smet,Bahram Bodaghi,Carlos Pavesio,Douglas A Jabs,Srinivas Sadda,David Sarraf,Vishali Gupta,
PURPOSETo develop imaging-based measures for disease assessment in non-infectious posterior uveitis (NIPU).DESIGNA mixed-methods design, beginning with a review of previously developed imaging recommendations formulated by separate subcommittees of the Multimodal Imaging in Uveitis (MUV) initiative, followed by a structured consensus process using the Nominal Group Technique (NGT), facilitated by an independent expert committee.METHODSAn expert committee reviewed and extracted all consensus-based imaging recommendations by the MUV subcommittee manuscripts focused on five major NIPU entities. The primary objective was to categorize imaging features as suggestive of active disease (SAD), suggestive of inactive disease (SID), or equivocal. This process was conducted using the NGT to reach consensus-based imaging measures. These recommendations were further voted upon by members of the full task force.RESULTSA total of 49 imaging statements were deliberated using two rounds of NGT and independent voting. For the five included diseases, a total of 21 statements qualified as features of SAD, whereas 12 statements were classified as SID. The remaining 16 statements were categorized as equivocal features, that need further investigation to determine whether the disease is active.CONCLUSIONSThis study builds upon the multinational efforts of the MUV initiative to extend the Standardization of Uveitis Nomenclature (SUN) work through the integration of additional multimodal imaging information. By defining clear imaging-based outcome measures for NIPU, it establishes a structured framework supporting objective disease assessment. These standardized imaging measures are expected to enhance the utility of multimodal imaging in both routine uveitis care and future clinical trials.
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