A comparison of stereoscopic fluorescein angiography with indocyanine green videoangiography in age-related macular degeneration.

PURPOSE: To correlate features of indocyanine green (ICG) videoangiography with stereo film fluorescein angiography (FA) in the analysis of age-related macular degeneration (AMD). DESIGN: A retrospective study with concurrent comparison of two methods of assessment on one set of patients with AMD undergoing sequential FA-ICG videoangiography. METHODS: One hundred four patients with AMD who had undergone immediately sequential FA-ICG videoangiography were selected in a consecutive fashion from the photographic files of the Casey Eye Institute. Three interpreters independently graded in an unbiased fashion the FA features of AMD. These were compared with ICG videoangiography features of hypocyanescence (ICG videoangiography hypofluorescence), moderate or intense hypercyanescence (ICG videoangiography hyperfluorescence), or absence of fluorescence over background (ICG videoangiography isocyanescence). We also assessed ICG videoangiography features in the opposite eye of those with choroidal neovascularization (CNV) by FA in one eye by examining an additional 96 FA-ICG videoangiography scans. MAIN OUTCOME MEASURES: Outcomes were the ICG videoangiography characteristics of classic and occult CNV, serous pigment epithelial detachments (SPEDs) both with and without CNV, macular hemorrhage, and the comparative size of these features. RESULTS: There were 25 eyes that had significant macular hemorrhage by FA. Of these, the FA revealed CNV in its entirety under or near the hemorrhage in 11. The ICG examination revealed all 11 plus an additional 12 hypercyanescent features that were not visible by FA. Although 26 of 32 SPEDs had CNV by FA analysis, 31 of 32 had well-defined hypercyanescence under or at the SPED edge by ICG videoangiography. Eighty-seven percent of eyes with classic choroidal neovascular membranes (CCNV; 20 of 23) and 93% of eyes with fibrovascular pigment epithelial detachments (FVPED; 66 of 71) were hypercyanescent with distinct edges. Fifty percent of eyes with only late leakage of undetermined source (LLUS) were hypercyanescent, whereas 50% were isocyanescent on ICG videoangiography. There were four of 104 eyes in which ICG videoangiography revealed poorly defined hypercyanescent areas when, by FA, there were only drusen or elevated blocked fluorescence. Indocyanine green videoangiography revealed only three eyes with poorly defined hypercyanescence of 200 fellow eyes in patients with unilateral AMD. CONCLUSIONS: Indocyanine green videoangiography correlated fairly well with stereoscopic FA for the presence of CCNV or FVPED, but correlated poorly when LLUS was present. In certain cases where CNV was associated with SPED or macular hemorrhage, ICG videoangiography demonstrated features not apparent on FA.

Clinically significant macular edema in type I diabetes. Incidence and risk factors.

PURPOSE: To examine incidence of and risk factors for clinically significant macular edema in persons with type I diabetes. METHODS: A group of 189 persons with type I diabetes, recruited from a summer camp for children with diabetes and from practices of local physicians, were participants in a longitudinal study with annual follow-up visits which included physical and ophthalmologic examinations and color stereo fundus photographs of each eye, centered on the disc and macula. Subjects were free of proliferative retinopathy at study baseline. Ages ranged from 3 to 40 years, duration of diabetes ranged from 0 to 12 years, mean glycosylated hemoglobin (Hgb A1c) was 12.2% (range, 6.4%-21.5%), and average follow-up was 6.1 years. Presence of clinically significant macular edema was defined as in the Early Treatment Diabetic Retinopathy Study. RESULTS: In a total of 41 persons (62 eyes), clinically significant macular edema developed during study follow-up. Cumulative risk of clinically significant macular edema was 0 until 7 years' duration of diabetes. The cumulative risk of clinically significant macular edema increased linearly for each year of duration between 10 and 20 years, with an average annual increase of approximately 6.7%. Significant risk factors for clinically significant macular edema were older age at diagnosis, male sex, and higher Hgb A1c level. Systolic and diastolic blood pressure, proteinuria, body mass index, race, initial presence of retinopathy, and use of antihypertensives did not significantly affect the risk of clinically significant macular edema. CONCLUSION: Older age at diagnosis of diabetes, male sex, and higher Hgb A1c levels (poorer control of blood glycemic levels) significantly increase the risk of clinically significant macular edema in persons with type I diabetes. These data extend the evidence implicating worse glycemic control as a cause of clinically significant macular edema, even within a population with relatively loose control.

Fundus photographic and fluorescein angiographic characteristics of pseudoholes of the macula in eyes with epiretinal membranes.

BACKGROUND: The fluorescein angiographic characteristics in eyes with pseudoholes of the macula associated with epiretinal membranes have not been studied extensively. METHODS: Stereo photographs and fluorescein angiograms from 83 consecutive eyes of 80 patients with pseudoholes of the macula were evaluated by two independent graders for epiretinal membrane opacity, fluorescence in the base of the pseudohole, and late perifoveal pooling of dye. RESULTS: Hyperfluorescence in synchrony with choroidal fluorescence appeared within the base of the pseudohole in 52 (63%) of the 83 eyes studied. The hyperfluorescence was smaller than the pseudohole in 37 (45%) eyes. Diffuse hyperfluorescence filled the pseudohole in 15 (18%) eyes. No fluorescence was seen in 20 (24%) eyes. Eleven (13%) eyes could not be graded due to coexistent macular disease or media opacity. Fluorescence within the area of pseudohole was less common in eyes with opaque epiretinal membranes than in eyes with visible or transparent epiretinal membranes (P = 0.002). Fluorescence within the area of the pseudohole was also less common in eyes with evidence of macular edema on fluorescein angiography (P < 0.001). The mean visual acuity was better for eyes with hyperfluorescence within the area of the pseudohole than for eyes without hyperfluorescence (P < 0.01). CONCLUSION: A common fluorescein angiographic characteristic associated with pseudoholes of the macula is early hyperfluorescence within the area of the pseudohole. This hyperfluorescence coincides with choroidal filling and appears to be a form of transmission defect rather than a blocking of surrounding choroidal fluorescence by the epiretinal membrane. This central hyperfluorescence may result in misdiagnosis of the macular pseudohole as a full-thickness macular hole.

Fluorescein angiographic characteristics of macular holes before and after vitrectomy with transforming growth factor beta-2.

We evaluated the fluorescein angiographic features of full-thickness macular holes before and after vitrectomy, fluid-gas exchange, and instillation of transforming growth factor beta-2 in 43 eyes in a masked fashion to evaluate the angiographic characteristics of macular holes preoperatively and the changes that occur with successful and unsuccessful closure of the macular hole. Hyperfluorescence was present in the base of the macular hole preoperatively in 34 of 43 eyes (79.1%), was questionable in eight of 43 eyes (18.6%), and was definitely absent in only one of 43 eyes (2.3%). The hyperfluorescence in the base of the macular hole disappeared in 19 of 20 eyes (95%) with successful closure of the macular hole (P < .00001) and appeared to be caused by blocked fluorescence at the site of the macular hole. The photographic features of eyes with unsuccessful closure of the macular hole changed little, except that the size of the cuff of neurosensory detachment around the hole increased and was associated with decreased postoperative visual acuity. These angiographic changes support the presence of a glial tissue plug bridging a small defect in the fovea of eyes with successful closure of a macular hole.