巨细胞病毒性视网膜炎多模态影像指南：MUV 工作组第15号报告
该指南由国际葡萄膜炎与视网膜专家组成的 MUV 工作组制定，基于系统文献回顾和名义群体技术形成共识。指南明确彩色眼底照相是 CMVR 评估的核心基线及随访手段，OCT 与 FFA 为检测并发症的补充工具，OCTA 和 ICGA 作用有限。
要点
- 彩色眼底照相是 CMVR 基线和随访最核心的影像方式，超广角照相有助发现周边卫星灶。
- OCT 有助识别内层视网膜坏死、Cme 及视网膜前膜等并发症。
- FFA 有助识别小动脉闭塞、CME 及视盘渗漏，OCTA 和 ICGA 作用有限。
核心结论
- 临床检查联合彩色眼底照相仍是评估 CMVR 的主要方法，OCT 和 FFA 为检测眼部并发症的补充工具。
研究设计与样本
- 共识指南，由国际葡萄膜炎与视网膜专家组成的 MUV 工作组基于系统文献回顾和名义群体技术制定，最终由全体成员投票。
关键影像表现/征象
- 活动性视网膜炎进展边缘在眼底自发荧光上可表现为边界特征，愈合病灶呈边界清晰的低自发荧光。
- OCT 可显示内层视网膜坏死及视网膜层受累情况。
- FFA 可显示小动脉闭塞、CME 及视盘渗漏。
临床应用与阅片要点
- 报告时应以彩色眼底照相描述病灶形态、范围、边界及治疗反应。
- 对免疫恢复性葡萄膜炎患者，应加做 OCT 和 FFA 以排查 CME、视网膜前膜等并发症。
局限性
- 本文为共识指南，未提供敏感度、特异度或 AUC 等诊断准确性数值。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
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.
引用
- Leal I, Agarwal A, Berkenstock M, et al. Evidence and Consensus-Based Imaging Guidelines in Cytomegalovirus Retinitis: Multimodal Imaging in Uveitis (MUV) Task Force - Report 15. Ophthalmol Retina. 2026. PMID: 42119730. doi:10.1016/j.oret.2026.05.004
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。