Qualitative and Quantitative Assessment of Vitreous Inflammation in Uveitis: Current Limitations and Emerging Diagnostic Approaches.

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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 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.

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