Work-up in patients with retinal vasculitis: A systematic review and meta-analysis: International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) Report 2.

Abstract

This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conducted in 5 databases and registered in PROSPERO (CRD42023489232). Studies included articles on at least 10 patients with RV without publication date or language restrictions. RV was categorized as secondary RV if they were associated with systemic disease, syndromic if they were associated with a syndromic ocular disease without systemic disease, idiopathic RV without association to systemic or syndromic ocular diseases. This report includes 84 studies analyzing 3480 patients with RV. Among infectious causes, tuberculosis tests were frequently reported, with TST/IGRA positivity observed in 31.4 % (95 % CI: 17.2-50.2 %) of de novo RV cases, increasing to 64.7 % (95 % CI: 47.8-78.9 %) in confirmed tubercular RV and 65.7 % (95 % CI: 39.0-85.1 %) in Eales disease. Chest radiograph abnormalities were present in 21.8 % (95 % CI: 12.9-33.8 %) of tubercular RV cases. Non-infectious causes showed notable regional variability. HLA-B51 positivity was 1 % (95 % CI: 0.03-3.1 %) in de novo RV, but rose to 61.4 % (95 % CI: 23.1-89.4 %) in Behçet's RV. Sarcoidosis RV revealed noncaseating granulomas in 80.5 % (95 % CI: 9.7-99.4 %), with angiotensin-converting enzyme elevation in 4.6 % (95 % CI: 2.3-9.1 %). This study highlights significant geographic variability in RV etiologies. Tuberculosis remains a key infectious cause, while non-infectious causes vary regionally. Region-specific diagnostics and Bayesian testing protocols are critical to improving diagnostic accuracy and patient outcomes.