Indocyanine Green Videoangiography of Choroidal Neovascularization

Lee²,

et al. 2015

Ophthalmologica

Purpose: To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA). Methods: Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups. Results: The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72). Conclusions: ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.

Section: Introductionmentioning

confidence: 99%

Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography

Lee²,

et al. 2015

Ophthalmologica

“…The diagnosis of PCV is best made using ICGA, as it allows visualization of choroidal vasculature after the initial transit of dye. 12,14 ICGA is a relatively expensive investigation compared with FA and in many parts of the world is not a routine investigation for patients presenting with serosanguineous maculopathy especially in those in which PCV is seen with reduced frequency such as Europe and the United States. 10,15,16 Our findings suggest that a diagnosis of PCV is highly likely in the presence of a haemorrhagic PED and we would, therefore, advocate the use of ICGA to investigate those patients presenting with this clinical feature on fundoscopy, especially in those of Chinese ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Haemorrhagic pigment epithelial detachment as a predictive feature of polypoidal choroidal vasculopathy in a Chinese population

Cackett

Htoon

Wong

et al. 2009

Eye

Purpose To determine the frequency of haemorrhagic pigment epithelial detachment (PED) among patients presenting with either polypoidal choroidal vasculopathy (PCV) or choroidal neovascularization (CNV) and calculate the degree to which the presence of a haemorrhagic PED can be used to predict the diagnosis of PCV. Methods A retrospective review of 290 eyes of 253 patients presenting to the Singapore National Eye Centre with serosanguineous maculopathy. Patients underwent ophthalmologic examination including digital colour fundus photography and stereoscopic fluorescein angiography and indocyanine green angiography (ICGA). Classification into PCV or CNV was based on ICGA findings, and presence or absence of haemorrhagic PED was documented. Results In total, 138 eyes of 123 patients were diagnosed with PCV and 152 eyes of 130 patients with CNV. A haemorrhagic PED was a significantly more common (Po0.001) presenting feature in PCV eyes (63, 45.7%) than CNV eyes (6, 3.9%) (odds ratio (OR) 20.4, 95% confidence interval (CI) 8.5-49.4). Age-related maculopathy was found significantly more frequently (Po0.001) in the unaffected fellow eye of CNV patients (57, 52.8%) than PCV patients (28, 22.8%) (OR 3.2, 95% CI 1.8-5.7). Conclusions In patients of Chinese ethnicity, a haemorrhagic PED is significantly more likely to be the presenting feature of PCV than CNV. Patients presenting with this clinical feature should make the clinician suspicious of an underlying diagnosis of PCV.

“…Since the subfoveal choriocapillary circulation is not always visible on FA because the macular xanthophyll pigment absorbs the exciting blue light used in FA, SLO-ICGv may provide greater information with regard to the choriocapillary circulation than FA. In addition, the choriocapillary circulation over areas of thin subretinal/subRPE hemorrhage may be obscured on FA, but be visible on SLO-ICGv because of the lack of absorption of the exciting or emitted SLO-ICGv infrared light by hemoglobin [14][15][16][17][18]. We used two diagnostic tools stereoscopic, FA and SLO-ICGv, to assess the choroidal circulation [19][20][21][22][23][24][25] in ARMD-eyes with SFCNVM both before and after submacular surgery.…”

Section: Discussionmentioning

confidence: 99%

Choroidal hypoperfusion after surgical excision of subfoveal neovascular membranes in age-related macular degeneration

et al. 1997

Purpose. To study the choroidal circulation after surgical excision of subfoveal choroidal neovascular membranes (SFCNVM) in age-related macular degeneration (ARMD). Methods. Twelve eyes of eleven patients with ARMD that underwent surgical excision of SFCNVMs were evaluated with stereoscopic color fundus photography, stereoscopic fluorescein angiography (FA) and scanning laser ophthalmoscope-indocyanine green videoangiography (SLOICGv). The patients were followed for a mean of 7.9 months (range 2 to 14 months). Results. Preoperatively, all eyes had angiographic evidence of a SFCNVM, with SLO-ICGv showing the presence of a choriocapillary blush. Postoperatively, stereoscopic color fundus photographs documented that the bed of the surgical excision was characterized by an absence of visible retinal pigment epithelial (RPE) pigmentation in all eyes. Stereoscopic FA of the excision bed revealed choriocapillary hypofluorescence with visible dye perfusion in the underlying medium and large choroidal vessels in all eyes. SLO-ICGv of the excision bed disclosed the presence of perfused medium and large choroidal vessels, but a marked choroidal hypofluorescence with loss of the choriocapillary and small choroidal vascular filling within the excision bed in eleven of the twelve eyes. Conclusion. Our results indicate that both choriocapillary and small choroidal vascular filling is frequently abnormal or absent in the bed of surgically excised subfoveal neovascular membranes in ARMD. This finding, which may represent either pathologic or iatrogenic choriocapillary and small choroidal vascular atrophy or occlusion with preservation of perfusion in the underlying medium and large choroidal vessels, may influence structural and visual recovery after submacular surgery for ARMD, despite RPE transplantation or regeneration.