Usefulness of fluorescein angiography in predicting the size of the atrophic area after surgical excision of choroidal neovascularization.

Twenty consecutive patients affected by age-related macular degeneration (AMD) complicated by subfoveal and juxtafoveal choroidal neovascularization (CNV) underwent a surgical removal of the membrane. The patients were divided into two groups: group A = CNVs 2 months. The surgical excision of the CNV was also performed in 10 cases of multifocal choroidopathies and idiopathic CNV. The atrophic area after surgery was larger in AMD than in multifocal choroidopathies or idiopathic CNV (p < 0.001). In AMD the atrophic area after surgical excision of the CNV was larger in group B than in group A (p < 0.05). The area of the CNV + the hyperfluorescent halo observed in the late phase of fluorescein angiography before surgery was 84.6% of the atrophic area after surgery. Our observations could be helpful to the surgeon for a more accurate evaluation of the expected size of the atrophic area after surgical removal of a CNV, thus allowing a better selection of the patients for whom surgery could be of some benefit.

Indocyanine green angiography of retinal pigment epithelial tears.

PURPOSE: To investigate the fluorescein and indocyanine green (ICG) features before and after retinal pigment epithelial tear. METHODS: Fluorescein and ICG videoangiography were performed in 30 patients affected by age-related macular degeneration either complicated by tear of the retinal pigment epithelium (25 eyes) or by pigment epithelial detachment with pretear characteristics (5 eyes). RESULTS: At the pretear stage fluorescein angiography (FA) showed in all cases signs of occult CNV associated with delayed, slow and uneven filling of the pigment epithelium detachment. In 2 eyes the ICG filling of the retinal pigment epithelial detachment was seen. Progression to the tear stage was seen in 4 eyes where a CNV was evident on ICG angiography; in two eyes within one month after laser photocoagulation. At the tear stage FA showed an area of marked hyperfluorescence with well defined margins. Adjacent to the exposed area the torn RPE was markedly hypofluorescent during all angiographic phases. The bare choroid was always hypo or normofluorescent on ICG angiography. The torn retinal pigment epithelium showed moderate hypofluorescence. The exact seat and extension of CNVs could be visualized in 20 cases (67%; 95% C.I., 50-84%) with ICG angiography vs. 6 cases (20%; 95% C.I., 6-34%) with FA (p<0.001). CONCLUSIONS: ICG angiography did not add anything substantial to the analysis of frank tears. The most useful application of ICG angiography in this disease is the visualization of the seat and extension of the associated CNV In fact, it is well known that laser treatment of a pigment epithelial detachment at the pretear stage may facilitate the development of a tear of the RPE.

Optical coherence tomography (OCT) in idiopathic polypoidal choroidal vasculopathy (IPCV).

PURPOSE: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a distinct clinical entity characterized by an edematous maculopathy and typical choroidal vascular change. The purpose of this study is to evaluate the use of optical coherence tomography (OCT) for diagnosing of this disease. METHODS: 4 patients affected by IPVC (mean age 71-84 years) underwent biomicroscopy with a three mirror conctact lens, fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT (Humphrey Zeiss) scan. RESULTS: in all 4 cases OCT tomograms acquired at the location of the typical choroidal abnormalities demonstrated by ICGA, revealed a characteristic hyper-reflectivity in the choroidal layers. CONCLUSION: ICGA is essential to diagnose IPVC, but OCT may be able to identify characteristic reflectivity patterns.

Choroidal findings in the course of idiopathic serous pigment epithelium detachment detected by indocyanine green videoangiography.

PURPOSE: To analyze the choroidal alterations associated with idiopathic serous pigment epithelium detachment. METHODS: Twenty-five consecutive patients affected by idiopathic serous pigment epithelium detachment underwent ophthalmoscopy, fluorescein angiography, and indocyanine green videoangiography. RESULTS: On indocyanine green videoangiography an early, complete, and homogeneous filling of the pigment epithelium detachment was always observed. In the late phases, the indocyanine green pattern depended on the size of the detachment. An idiopathic serous pigment epithelium detachment larger than the diameter of one optic disk was still hyperfluorescent in the late phases of indocyanine green videoangiography and was surrounded by a ring of brighter hyperfluorescence. An idiopathic serous pigment epithelium detachment smaller than the diameter of one optic disk usually could be visualized in the late phases as a hypofluorescent area surrounded by a hyperfluorescent ring. In 30 eyes (83.3%), choroidal hyperpermeability was observed. An irregular dilatation of the choroidal veins at the site or within an area the size of one disk diameter from the detachments could be visualized on indocyanine green videoangiography in 12 of 36 affected eyes (33.3%); in three cases an active focus of central serous chorioretinopathy with subretinal leakage developed in the follow-up period. CONCLUSION: The observation that pigment epithelium detachments frequently are associated with choroidal leakage and venous dilatation supports the hypothesis that an idiopathic serous pigment epithelium detachment is a variant of central serous chorioretinopathy. Moreover, the choroidal permeability alterations detected by indocyanine green videoangiography would support the theory of Gass that idiopathic serous pigment epithelium detachments could be caused by exudation of fluids from the choroidal vessels.

Indocyanine green angiographic findings in multifocal choroidopathies.

With high definition videoangiography (TOPCON IMAGEnet H1024) the Authors studied 41 patients affected by multifocal choroidopathies (MC) (68 eyes with ophthalmoscopic or indocyanine green angiographic evidences): 29 females and 12 males; age 21-51 years with a follow up of 6-29 months. In the light of the evidence provided by FA and ICG the Authors present a classification of MC in three stages: Stage 1 of subclinical choroidal activity (5 eyes) characterised by the presence of hypofluorescent or hyperfluorescent spots visible only in the late phases of ICGA; stage 2 of clinically evident choroidal activity (45 eyes) in FA the spots are hypofluorescent in the early phases and hyperfluorescent with a slight diffusion in the late phases, in ICGA either hypofluorescent spots or less frequently hyperfluorescent spots and choroidal permeability alterations can be observed; stage 3 or healed stage (18 eyes) in FA the spots are hyperfluorescent without late leakage, in ICGA hypofluorescence can be observed during all angiographic phases. In 5 patients in stage 1 of subclinical activity, a systemic steroid therapy induced a regression of the hypofluorescent spots in ICGA, in 2 cases the regression of hyperfluorescent spots in ICGA was observed after systemic antibiotic therapy. The authors underline that ICGA could be a particularly useful tool for an early diagnosis and clinical monitoring of MC.

Indocyanine green angiographic findings in idiopathic choroidal neovascularization.

PURPOSE: Evaluation of choroidal alterations associated with idiopathic choroidal neovascularization (ICNV) and the possible relation between this affection and Multifocal Choroidopathies (MC). METHODS: The authors analysed, using high definition videoangiography, the choroidal findings in 21 consecutive patients affected by ICNV (7 males and 14 females; 19-46 years; mean age: 31.8 years); with a follow-up at 5-30 months (mean 13 months). Moreover, a retrospective study of 20 cases of ICNV (11 males and 9 females; age: 17-39 years; mean age: 29.3 years) with a follow-up at 6-11 years (mean 8.9), was performed. RESULTS: In 7 eyes, the indocyanine green angiography (ICGA) showed choroidal hypofluorescent spots similar to those observed in MC (in 3 cases even in the fellow unaffected eye), in 2 of them the regression of the spots was observed after steroid therapy. In 2 eyes, the ICGA revealed hyperfluorescent spots; in one of them the complete regression of the spots after oral cyprofloxacine was observed. In 6 patients (10 eyes), choroidal permeability alterations could be visualized (in 4 cases even in the unaffected eye). CONCLUSIONS: The indocyanine green angiographic findings (hypo and hyperfluorescent spots, choroidal permeability alterations) could support the theory of Gass which considers that ICNV is not idiopathic but secondary to a widespread choroidal inflammatory disease. The similarity of the ICGA alterations in ICNV and MC, the observation that cases of ICNV would become MC in the follow-up, could allow the hypothesis of a close connection between these two affections.

Indocyanine green angiographic findings in multifocal choroidopathies.

With high definition videoangiography (TOPCON IMAGEnet H1024) the Authors studied 41 patients affected by multifocal choroidopathies (MC) (68 eyes with ophthalmoscopic or indocyanine green angiographic evidences): 29 females and 12 males; age 21-51 years with a follow up of 6-29 months. In the light of the evidence provided by FA and ICG the Authors present a classification of MC in three stages: Stage 1 of subclinical choroidal activity (5 eyes): characterised by the presence of hypofluorescent or hyperfluorescent spots visible only in the late phases of ICGA; stage 2 of clinically evident choroidal activity (45 eyes): in FA the spots are hypofluorescent in the early phases and hyperfluorescent with a slight diffusion in the late phases, in ICGA either hypofluorescent spots or less frequently hyperfluorescent spots and choroidal permeability alterations can be observed; stage 3 or healed stage (18 eyes): in FA the spots are hyperfluorescent without late leakage, in ICGA hypofluorescence can be observed during all angiographic phases. In 5 patients in stage 1 of subclinical activity, a systemic steroid therapy induced the regression of the hypofluorescent sports in ICGA, in 2 cases the regression of hyperfluorescent spots in ICGA was observed after systemic antibiotic therapy. The authors underline that ICGA could be a particularly useful tool for an early diagnosis and clinical monitoring of MC.