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Diagnostics
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Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases
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Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 30 April 2027 | Viewed by 6975

Editor

Dr. Dimitrios Kalogeropoulos

E-Mail Website
Guest Editor
Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
Interests: clinical ophthalmology; eye disease; uveitis; cataract; retina

Special Issue Information

Dear Colleagues,

Uveitis and inflammatory vitreoretinal disorders represent a heterogeneous group of diseases that continue to challenge clinicians due to their complex etiologies, overlapping phenotypes, and variable clinical presentations. Rapid advances in imaging technologies and molecular diagnostics have revolutionized our ability to detect, monitor, and characterize intraocular inflammation. These developments offer unprecedented opportunities to improve the precision and timeliness of diagnosis, guide personalized therapy, and enhance patient outcomes.

We are pleased to invite you to contribute to this Special Issue, “Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases”, which aims to highlight current and emerging diagnostic strategies in this field. This topic aligns with the scope of Diagnostics, emphasizing translational advances and innovative technologies that enhance diagnostic accuracy in intraocular inflammatory disease.

This Special Issue welcomes original research articles, clinical studies, and comprehensive reviews addressing imaging, molecular, and integrated diagnostic approaches. Research areas may include, but are not limited to, the following:

  • Imaging Diagnostics: OCT and OCTA biomarkers of inflammatory activity, choroidal flow metrics, and multimodal imaging approaches—including fundus autofluorescence, fluorescein and indocyanine green angiography, ultra-widefield, and adaptive optics imaging—in uveitis.
  • Molecular and Cellular Diagnostics: Cytokine profiling, proteomics, metabolomics, flow cytometric immunophenotyping, microbiome analysis, and next-generation sequencing of intraocular fluids.
  • Integrative and Novel Approaches: AI-based image analysis, multimodal data fusion, intraoperative imaging innovations, and validation of diagnostic algorithms.
  • Clinical Applications: Early diagnosis of masquerade syndromes, imaging-guided therapeutic monitoring, and real-world diagnostic workflows in complex uveitis.

We look forward to receiving your valuable contributions that will advance our understanding of diagnostic innovations in inflammatory vitreoretinal diseases.

Dr. Dimitrios Kalogeropoulos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • uveitis
  • inflammatory retinal disease
  • multimodal imaging
  • OCTA
  • imaging biomarkers
  • vitreous diagnostics
  • aqueous humor analysis
  • cytokine profiling
  • intraocular inflammation
  • infectious and non-infectious uveitis
  • AI in imaging
  • personalized diagnostics

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

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15 pages, 16589 KB  
Article
Serum Procalcitonin to Support Early Triage for Possible Systemic Infection in Patients with Endophthalmitis
by Sun Myung Son, Jae Hyup Lee, Young Jin Kim, Hyun Duck Kwak, Jaewook Yang and Dong Geun Kim
Diagnostics 2026, 16(9), 1331; https://doi.org/10.3390/diagnostics16091331 - 29 Apr 2026
Viewed by 598
Abstract
Background: Endophthalmitis is an ophthalmic emergency in which early identification of concurrent systemic infection is important for appropriate clinical management, yet this distinction is often challenging at presentation. Methods: We conducted a retrospective cohort study of patients diagnosed with endophthalmitis at a tertiary [...] Read more.
Background: Endophthalmitis is an ophthalmic emergency in which early identification of concurrent systemic infection is important for appropriate clinical management, yet this distinction is often challenging at presentation. Methods: We conducted a retrospective cohort study of patients diagnosed with endophthalmitis at a tertiary referral center between 2017 and 2023. Serum procalcitonin (PCT), C-reactive protein (CRP), white blood cell count, and absolute neutrophil count obtained at presentation were analyzed in relation to clinical classification and systemic infection status, with exploratory receiver operating characteristic (ROC) analyses and Decision Curve Analysis (DCA) used to evaluate diagnostic performance and clinical utility. Results: Among 152 patients, serum inflammatory marker levels were significantly higher in patients classified as having endogenous endophthalmitis than in exogenous cases (p < 0.01), with the greatest separation observed for PCT and CRP. In ROC analyses, PCT demonstrated greater discriminatory capacity for concurrent systemic infection than other markers, with a sensitivity of 91.8%, specificity of 97.9%, and an area under the curve (AUC) of 0.964 at an ROC-derived threshold of 0.11 ng/mL. CRP also showed high discriminatory performance (AUC 0.947), whereas white blood cell count and absolute neutrophil count showed lower AUC values. In patients presenting with endophthalmitis and concurrent uncontrolled systemic infection, PCT showed a higher AUC than CRP (0.995 vs. 0.939). Furthermore, DCA demonstrated that a comprehensive model combining inflammatory biomarkers with clinical risk factors provided the highest net benefit for clinical triage. Conclusions: These findings suggest that serum PCT, particularly when integrated into a multidimensional clinical assessment, may serve as a valuable adjunctive tool to support early triage when systemic infection is a concern. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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Review

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16 pages, 3682 KB  
Review
Tumor or Inflammation? How Multi-Modality Image Fusion and Shear Wave Elastography Can Help Solve the Diagnostic Dilemma
by Efstathios T. Detorakis, George Bontzos and Eleni E. Drakonaki
Diagnostics 2026, 16(15), 2300; https://doi.org/10.3390/diagnostics16152300 - 23 Jul 2026
Viewed by 357
Abstract
Differentiating intraocular tumors from inflammatory conditions remains a major diagnostic challenge in ophthalmology, particularly in masquerade syndromes where clinical and imaging features overlap. Despite advances in ocular imaging, no single modality provides sufficient diagnostic specificity. This narrative review synthesizes current evidence on optical [...] Read more.
Differentiating intraocular tumors from inflammatory conditions remains a major diagnostic challenge in ophthalmology, particularly in masquerade syndromes where clinical and imaging features overlap. Despite advances in ocular imaging, no single modality provides sufficient diagnostic specificity. This narrative review synthesizes current evidence on optical imaging modalities, ultrasonography, and elastography, focusing on their complementary roles in intraocular disease characterization, with emphasis on shear wave elastography (SWE) within a multimodal framework. Conventional imaging provides partial insights: OCT and ultrasonography define structural features, while angiographic techniques assess vascular behavior. Elastography adds a biomechanical dimension by enabling in vivo assessment of tissue stiffness. Malignant lesions typically exhibit increased stiffness and heterogeneity, whereas inflammatory processes show more variable profiles, yet overlap exists. Integrating structural, vascular, and biomechanical data improves pattern recognition and diagnostic confidence. A tri-axis fusion model and a practical diagnostic workflow are proposed to support clinical decision-making. Multi-modality image fusion represents a shift toward hybrid multi-dimensional tissue characterization in ophthalmology. The addition of elastography may assist in the differential diagnosis process between intraocular tumors and inflammatory conditions. Further standardization, validation, and integration with artificial intelligence are required for routine clinical implementation. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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12 pages, 1574 KB  
Review
Qualitative and Quantitative Assessment of Vitreous Inflammation in Uveitis: Current Limitations and Emerging Diagnostic Approaches
by Maria Carmela Saturno, Oscar Matteo Gagliardi, Maurizio La Cava, Chiara Ciccarè, Alice Bruscolini, Alessandro Lambiase and Danilo Iannetta
Diagnostics 2026, 16(12), 1886; https://doi.org/10.3390/diagnostics16121886 - 17 Jun 2026
Viewed by 359
Abstract
Accurate assessment of vitreous inflammation is essential for the diagnosis, monitoring and management of uveitis. Traditionally, vitritis has been evaluated using subjective clinical grading systems based on vitreous haze and cellular infiltration, which are limited by interobserver variability and poor reproducibility, particularly in [...] Read more.
Accurate assessment of vitreous inflammation is essential for the diagnosis, monitoring and management of uveitis. Traditionally, vitritis has been evaluated using subjective clinical grading systems based on vitreous haze and cellular infiltration, which are limited by interobserver variability and poor reproducibility, particularly in cases of mild or subclinical inflammation. In recent years, advances in ocular imaging have enabled the development of more objective, quantitative approaches. Ultra-widefield imaging, optical coherence tomography (OCT) and ultrasound-based techniques have provided new insights into structural alterations within the vitreous. In parallel, automated image analysis and artificial intelligence (AI)-based methods have improved the detection and quantification of inflammatory biomarkers, including vitreous hyperreflective foci and signal intensity-based metrics. Despite these advances, important limitations remain, including a restricted field of view, a lack of standardized segmentation algorithms and an incomplete representation of the entire vitreous cavity. No single modality currently provides a comprehensive and fully reproducible assessment of vitreous inflammation. This review summarizes current qualitative and quantitative methods for evaluating vitreous inflammation, highlighting their respective strengths and limitations. In addition, emerging diagnostic strategies, including multimodal imaging integration, AI-driven analysis and molecular biomarker profiling, are discussed as potential tools to improve accuracy, standardization and clinical applicability. The transition from subjective grading toward objective quantification of inflammatory burden represents a key step in advancing both clinical management and research in ocular inflammatory diseases. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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37 pages, 2398 KB  
Review
The Impact of Vitreoretinal Surgery in Patients with Uveitis: Current Strategies and Emerging Perspectives
by Dimitrios Kalogeropoulos, Sofia Androudi, Marta Latasiewicz, Youssef Helmy, Ambreen Kalhoro Tunio, Markus Groppe, Mandeep Bindra, Mohamed Elnaggar, Georgios Vartholomatos, Farid Afshar and Chris Kalogeropoulos
Diagnostics 2026, 16(2), 198; https://doi.org/10.3390/diagnostics16020198 - 8 Jan 2026
Cited by 2 | Viewed by 2564
Abstract
Uveitis constitutes a heterogeneous group of intraocular inflammatory pathologies, including both infectious and non-infectious aetiologies, often leading to substantial morbidity and permanent loss of vision in up to 20% of the affected cases. Visual impairment is most prominent in intermediate, posterior, or panuveitis [...] Read more.
Uveitis constitutes a heterogeneous group of intraocular inflammatory pathologies, including both infectious and non-infectious aetiologies, often leading to substantial morbidity and permanent loss of vision in up to 20% of the affected cases. Visual impairment is most prominent in intermediate, posterior, or panuveitis and is commonly associated with cystoid macular oedema, epiretinal membranes, macular holes, and retinal detachment. In the context of uveitis, these complications arise as a result of recurrent flare-ups or chronic inflammation, contributing to cumulative ocular damage. Pars plana vitrectomy (PPV) has an evolving role in the diagnostic and therapeutic approach to uveitis. Diagnostic PPV allows for the analysis of vitreous fluid and tissue using techniques such as PCR, flow cytometry, cytology, and cultures, providing further insights into intraocular immune responses. Therapeutic PPV can be employed for the management of structural complications associated with uveitis, in a wide spectrum of inflammatory clinical entities such as Adamantiades–Behçet disease, juvenile idiopathic arthritis, acute retinal necrosis, or ocular toxoplasmosis. Modern small-gauge and minimally invasive techniques improve visual outcomes, reduce intraocular inflammation, and may decrease reliance on systemic immunosuppression. Emerging technologies, including robot-assisted systems, are expected to enhance surgical precision and safety in the future. Despite these advances, PPV outcomes remain variable due to heterogeneity in indications, surgical techniques, and postoperative management. Prospective studies with standardized protocols, detailed subgroup analyses, and the integration of immunological profiling are needed to define which patients benefit most, optimize therapeutic strategies, and establish predictive biomarkers in uveitis management. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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Other

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11 pages, 1051 KB  
Case Report
Steroid-Induced Central Serous Chorioretinopathy in Uveitis: Diagnostic Challenges and Multimodal Imaging with a Primary Inflammatory Choriocapillaropathy Illustrative Case
by Maria Carmela Saturno, Claudia Smarra, Maurizio La Cava, Oscar Matteo Gagliardi, Alessandro Ansevini, Rosalia Giustolisi, Alessandro Lambiase and Danilo Iannetta
Diagnostics 2026, 16(16), 2679; https://doi.org/10.3390/diagnostics16162679 - 21 Aug 2026
Abstract
Background and Clinical Significance. Steroid-induced central serous chorioretinopathy (CSCR) is a potential complication in patients with uveitis receiving corticosteroid therapy and may be misinterpreted as persistent inflammatory activity. Inflammatory and iatrogenic subretinal fluid may coexist, particularly in primary inflammatory choriocapillaropathies (PICCPs), creating diagnostic [...] Read more.
Background and Clinical Significance. Steroid-induced central serous chorioretinopathy (CSCR) is a potential complication in patients with uveitis receiving corticosteroid therapy and may be misinterpreted as persistent inflammatory activity. Inflammatory and iatrogenic subretinal fluid may coexist, particularly in primary inflammatory choriocapillaropathies (PICCPs), creating diagnostic and therapeutic challenges. This narrative review discusses the pathophysiological mechanisms underlying steroid-induced CSCR and emphasizes the value of multimodal imaging in distinguishing inflammatory subretinal fluid from steroid-induced serous retinal detachment. Optical coherence tomography, fundus autofluorescence, fluorescein angiography and indocyanine green angiography provide complementary information that may guide accurate diagnosis and avoid inappropriate corticosteroid escalation. Case Presentation. An illustrative case of ampiginous choroiditis, a severe form of PICCP, complicated by bilateral steroid-induced CSCR shortly after initiation of high-dose corticosteroid therapy, is presented to highlight the clinical relevance of this complication and its therapeutic implications. Conclusions. Early recognition through multimodal imaging enabled prompt corticosteroid tapering and introduction of steroid-sparing immunosuppression, with subsequent marked anatomical and functional improvement. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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16 pages, 6139 KB  
Case Report
Immune Checkpoint Inhibitor-Induced Vogt–Koyanagi–Harada–like Disease Complicated by Inflammatory Macular Neovascularisation: A Case Report and Literature Review
by Maria-Eleni Papavasileiou, Panagiotis Stavrakas, Petroula Mitri, Panteleimon Kalaitzakis, George Makris and Antonios Ragkousis
Diagnostics 2026, 16(16), 2653; https://doi.org/10.3390/diagnostics16162653 - 20 Aug 2026
Viewed by 165
Abstract
Background and Clinical Significance: This paper presents a case of Vogt–Koyanagi–Harada (VKH)-like disease following nivolumab and ipilimumab therapy for squamous cell carcinoma of the lung, complicated by transient type 1 macular neovascularisation (MNV). Case Presentation: A 67-year-old man presented with reduced [...] Read more.
Background and Clinical Significance: This paper presents a case of Vogt–Koyanagi–Harada (VKH)-like disease following nivolumab and ipilimumab therapy for squamous cell carcinoma of the lung, complicated by transient type 1 macular neovascularisation (MNV). Case Presentation: A 67-year-old man presented with reduced visual acuity, more pronounced in the left eye, accompanied by headache and neurosensory hearing loss for 10 days. He had been receiving combination therapy with nivolumab and ipilimumab for approximately nine weeks. Slit-lamp examination and multimodal imaging revealed multiple serous retinal detachments, choroidal folds, and bacillary layer detachment. A bilateral VKH-like syndrome was considered the most likely diagnosis, consistent with an immune-related adverse event (irAE). High-dose systemic corticosteroids were initiated, resulting in marked anatomical improvement and recovery of visual acuity. Following multidisciplinary discussion with the patient’s oncologist, ipilimumab was permanently discontinued and nivolumab was rechallenged in combination with chemotherapy after resolution of the ocular adverse events, given the progression of the underlying malignancy. Notably, optical coherence tomography angiography (OCTA) additionally demonstrated a type 1 non-exudative MNV, which resolved spontaneously during follow-up. Conclusions: Nivolumab and ipilimumab, targeting PD-1 and CTLA-4, respectively, are effective anticancer therapies but may induce immune-related adverse events involving the eye. VKH-like disease is a rare but potentially vision-threatening complication. Early recognition and prompt treatment are essential for favourable visual outcomes. In summary, this is a rare case of VKH-like disease associated with nivolumab and ipilimumab therapy, complicated by transient inflammatory type 1 MNV. Clear guidelines are needed regarding management of ocular immune-related adverse events and decisions on continuation or discontinuation of life-prolonging immunotherapy. Full article
(This article belongs to the Special Issue Advanced Diagnostic Approaches in Uveitis and Inflammatory Vitreoretinal Diseases)
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