Comparison between indocyanine green angiography and outcome of surgical removal of choroidal neovascular membrane in age-related macular degeneration]

PURPOSE: To review the outcome of surgical removal of choroidal neovascular membranes in age-related macular degeneration as classified by indocyanine green angiographic findings. SUBJECTS AND METHOD: Surgery was performed in 42 eyes. They were divided into four types by indocyanine green angiographic findings prior to surgery. Type I comprised 29 eyes showing hyperfluorescence throughout the angiographic phases. Type II comprised 3 eyes showing hyperfluorescence during the early phase only. Type III comprised 5 eyes showing hyperfluorescence in the late phase only. Type IV comprised 5 eyes without hyperfluorescence throughout the angiographic phases. The results were evaluated according to the visual acuity expressed as log MAR before and after surgery. RESULTS: Visual acuity improved significantly in Types I, II, and III after surgery. Visual acuity did not improve in Type IV. CONCLUSION: The findings of indocyanine green angiography are thought to reflect the histological characteristics of the choroidal neovascular membrane. Neovascular membranes of Type IV may contain a smaller number of vessels and abundant fibrous tissue. Eye of Type IV will have atrophies in the neurosensory retina, retinal pigment epithelium, and choriocapillaris. Surgical removal of the choroidal neovascular membrane in Type IV is not effective in improving visual acuity.     

Correlation of Indocyanine Green Angiography Findings and Expression of Vascular Endothelial Growth Factor in Surgically Excised Age-related Macular Degeneration-related Choroidal Neovascular Membranes

Purpose: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes.Subject and Methods: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF.Results: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV.Conclusion: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.     

Correlation of indocyanine green angiography findings and expression of vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes

PURPOSE: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes. SUBJECT AND METHODS: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF. RESULTS: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV. CONCLUSION: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.     

Indocyanine green angiography and histopathology of choroidal neovascular membrane in age-related macular degeneration

PURPOSE: Histopathological investigation of the choroidal neovascular membrane (CNM) in age-related macular degeneration (AMD) patients who showed various findings in indocyanine green angiography (IA). METHODS: Before surgery, 20 eyes of 20 patients were classified into four types based on IA findings (Type I: both early and late phase hyperfluorescence; Type II: hyperfluorescence only in the early phase; Type III: hyperfluorescence only in the late phase; Type IV: virtually no hyperfluorescence in any phase). Seventeen surgically excised specimens stained with hematoxylin-eosin and azan, were examined by light microscopy. Three other specimens were examined by electron microscopy. RESULTS: Type I membrane showed many vascular channels not present in the surrounding retinal pigment epithelium (RPE) cells, and little fibrous tissue. Type II membrane had many vascular channels but RPE cells surrounded the CNM. Type III membrane showed few vascular channels and RPE cell proliferation. Type IV membrane showed dense fibrous tissue. CONCLUSION: The IA findings in AMD agreed with the CNM membrane structure in regard to the number of vascular channels, maturity of vessels, the extent of envelopment of RPE cells and the amount of fibrous tissue.     

Indocyanine green angiography is of value for the diagnosis of chronic central serous chorioretinopathy in elderly patients

Background: Central serous chorioretinopathy is characterized on indocyanine green angiography by areas of transient choroidal hyperfluorescence. These findings are thought to be the consequence of altered permeability of the choroidal vessels. · Methods: The indocyanine green angiograms of 41 patients between 40 and 60 years of age, with central serous chorioretinopathy and of 120 patients above 64 years of age with occult choroidal neovascularization due to age-related macular degeneration were reviewed for the presence of transient indocyanine green leakage. Twelve eyes of 9 patients above 64 years of age with (1) fluorescein leakage of undetermined source corresponding with well-delineated zone(s) of retinal pigmentary changes and (2) transient indocyanine green hyperfluorescence are reported in detail. · Results: Transient indocyanine green hyperfluorescence was seen in all eyes with central serous chorioretinopathy, either typical or chronic, and was seldom seen in occult choroidal neovascularization due to age-related macular degeneration. In the series of chronic serous chorioretinopathy in patients above 64 years of age, four classic choroidal neovascular membranes were found in 12 eyes. Most patients presented multizonal transient choroidal hyperfluorescence in both eyes on indocyanine green angiography. · Conclusion: Transient choroidal hyperfluorescence is suggestive for chronic central serous chorioretinopathy in older patients presenting retinal pigmentary disease with fluorescein leakage of undetermined source. Chronic central serous chorioretinopathy is not uncommonly associated with classic choroidal neovascularization in the elderly. Received: 25 January 1997 Revised version received: 15 September 1997 Accepted: 13 November 1997     

Observation of the ocular fundus by an infrared-sensitive video camera after vitreoretinal surgery assisted by indocyanine green.

PURPOSE: To investigate how long indocyanine green (ICG) dye remains in the ocular fundus and how the remaining dye interferes with ICG angiographic findings after vitreoretinal surgery assisted by ICG. METHODS: Eight eyes with macular hole, three with epiretinal membrane, and one with an intraocular foreign body were included. Those patients underwent vitrectomy facilitated by an intraocular administration of ICG. An infrared sensitive video camera was used to take fundus pictures pre- and postoperatively. In 2 of 12 cases, the authors performed ICG angiography at 2 weeks and at 3 months after the surgery. RESULTS: At 1 month after surgery, diffuse hyperfluorescence was observed throughout the posterior pole of the ocular fundus in all cases. The area where macular hole existed before the surgeries revealed hyperfluorescence in 6 of 8 eyes with macular hole (75%). These hyperfluorescent findings became less prominent with time postoperatively, while optic disk hyperfluorescence persisted for 12 months in all cases. In the early phase of ICG angiography at 2 weeks postoperatively, the retinal and choroidal circulation could be depicted. However, in the middle phase the choroidal veins were hardly visible. The angiographic pictures of the late phase mimicked those seen without intravascular administration of ICG. Even at 3 months after surgery, the optic nerve head revealed hyperfluorescence in the middle and late phases. CONCLUSIONS: The residual ICG in the ocular fundus produced prolonged hyperfluorescence after surgery. This abnormal condition affected ICG angiographic findings in the middle and late phases.     

Surgical management of subfoveal neovascularization in children.

OBJECTIVE: To report the authors' clinical experience with submacular surgery for subfoveal membranes in children and to evaluate the histopathologic findings of membranes in children with various etiologies of choroidal neovascularization. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 12 consecutive children with subfoveal choroidal neovascularization treated by vitrectomy and excision of the choroidal neovascular complex. INTERVENTION: Vitrectomy, excision of the choroidal neovascular complex, and air-fluid exchange. MAIN OUTCOME MEASURES: Visual acuity and recurrence of choroidal neovascular membrane. RESULTS: Preoperative visual acuities ranged from 20/60 to 20/800 (median, 20/300). Postoperative visual acuities ranged from 20/25 to 20/400 (median, 20/80) after an average follow-up of 20 months (range, 7-62 months). Ten of 12 eyes improved from immediate preoperative visual acuity, and four eyes developed recurrence of neovascular membranes over a mean follow-up of 18 months. Histopathologic examination of six excised membranes showed that the most common components of the membranes were retinal pigment epithelium, fibrocytes, vascular endothelium, and collagen. CONCLUSION: Selected eyes of children with subfoveal neovascular membranes and no evidence of membrane regression may benefit from submacular surgery. The histopathologic findings were similar to adult choroidal neovascularization not associated with age-related macular degeneration.     

Indocyanine green angiographic features in tuberculous chorioretinitis

PURPOSE: To determine choroidal involvement in presumed tuberculous posterior uveitis by examining indocyanine green angiographic features. METHODS: Indocyanine green angiography was performed according to a standard uveitis angiographic protocol in eight consecutive patients (15 eyes) with presumed posterior tuberculous uveitis. RESULTS: In 100% of the 15 examined eyes, indocyanine green angiography disclosed choroidal lesions that were subclinical, not detected by fundus examination or fluorescein angiography, in six (40%) of 15 eyes. Findings were classified into four main angiographic signs: (1) irregularly distributed, hypofluorescent areas in the early and intermediate phases of angiography that either became isofluorescent (type 1 hypofluorescence) or remained hypofluorescent (type 2 hypofluorescence) in the late phase; (2) numerous, small, focal, hyperfluorescent spots; (3) choroidal vessels that appeared fuzzy in the intermediate phase because of leakage, leading in the late phase to (4) diffuse choroidal hyperfluorescence. Type 1 hypofluorescent lesions, fuzzy choroidal vessels, and diffuse choroidal hyperfluorescence tended to regress after the initiation of antituberculous and corticosteroid treatment. Focal hyperfluorescence tended to be associated with longstanding disease. CONCLUSIONS: Indocyanine green angiography was useful in assessing and quantifying the as yet unknown extent of choroidal involvement in tuberculous posterior uveitis. Its characteristic appearance may be a valuable contribution to the diagnosis and monitoring of treatment response.     

Pigment epithelial detachments in age-related macular degeneration -- classification,differentiation and prognosis

BACKGROUND: A pigment epithelial detachment (PED) is an exudative manifestation of late age-related macular degeneration (AMD). Its long-term unfavourable prognosis is influenced by the association of a neovascular membrane. Seemingly identical PEDs in ophthalmoscopy can be further differentiated by fluorescein and indocyanine green angiography. The purpose of this prospective follow-up study was to determine the most reliable angiographic classification to distinguish PEDs in AMD and to evaluate their outcome. MATERIAL AND METHODS: 73 eyes of 68 patients with a PED in AMD were examined with simultaneous angiography with fluorescein and indocyanine green. 34 eyes were additionally scanned by retinatomography. Fluorescein angiographic classification comprises 4 types: 1. early hyperfluorescent type, 2. late hyperfluorescent type, 3. drusen type, 4. irregular fluorescent type. Indocyanine green angiographic classification consists of the following three groups: 1. angiographically no vascularisation, 2. associated choroidal neovascularisation, 3. associated polypoidal choroidal vasculopathy. RESULTS: Both classifications show statistically significant correlation with visual acuity (fluorescein classification: P = 0.0112, ICG-classification: P = 0.0004) and area of the PEDs (fluorescein classification: P = 0.0002, ICG-classification: P < 0.0001). ICG-classification additionally is significantly associated with the volume (P = 0.0008). Both classifications correlate (P = 0.0001). Factors influencing visual acuity are: age (P = 0.0044), associated neovascular membrane (P = 0.0004), area (P < 0.0001), volume (P = 0.0077) and height (P < 0.0001). CONCLUSIONS: PEDs in AMD can best be classified by indocyanine green angiography on the basis of an associated prognostically important neovascular membrane, which can only be further distinguished into choroidal neovascularisation or polypoidal choroidal vasculopathy by indocyanine green angiography. Statistical analysis shows qualitatively and quantitatively more significant results for the indocyanine green angiographic classification.     

Indocyanine green angiographic features prognostic of visual outcome in the natural course of patients with age related macular degeneration.

AIMS: To determine indocyanine green (ICG) angiographic features prognostic of visual acuity loss in eyes following a natural course of exudative age related macular degeneration (AMD). METHODS: 89 eyes of 72 patients (48 men, 24 women) aged between 50 and 87 years old (mean 69.5 (SD 8.8) years) with classic and/or occult choroidal neovascularisation (CNV) were reviewed. ICG angiographic features were classified as follows: type 1, well demarcated hyperfluorescence with late ICG leakage; type 2, well demarcated hyperfluorescence with no late dye leakage; type 3, poorly demarcated hyperfluorescence; type 4, no hyperfluorescence. Follow up ranged from 6 to 67 months (mean 19.2 (11.5) months). Logistic regression analyses were performed using change of visual acuity (worse or not) as the dependent variable, and patient age, sex, characteristics of fluorescein angiography (classic or occult CNV), location of CNV, and each ICG type as the independent variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Type 1 CNV was associated with the highest risk for visual acuity loss (OR: 7.50, CI: 1.42-39.55, p = 0.018) among the present variables. In contrast, CNV having no ICG leakage (type 2, 3, and 4), represented no significantly increased risk. CONCLUSION: Well demarcated hyperfluorescence with late ICG leakage appears to be predictive of visual acuity loss in eyes with CNV. Thus, ICG angiography may offer a useful means of predicting visual outcomes in AMD.     

Simultaneous indocyanine green and fluorescein angiography in retinal pigment epithelium tear using the confocal scanning laser ophthalmoscope.

PURPOSE: To describe the indocyanine green angiographic pattern of retinal pigment epithelium tears in the setting of age-related macular degeneration compared with the fluorescein angiographic features. METHODS: Twelve consecutive patients (12 eyes) with a retinal pigment epithelium tear underwent simultaneous indocyanine green angiography and fluorescein angiography with the confocal scanning laser ophthalmoscope. The findings for the two modes were compared. RESULTS: Choroidal neovascular membrane was evident beneath the rolled retinal pigment epithelium on indocyanine green angiograms in 11(92%) of 12 eyes: a focal neovascular membrane was apparent in five (42%) of 12 eyes, whereas a plaque neovascular membrane was seen in six (50%) of 12 eyes. In comparison, fluorescein angiography demonstrated late leakage as a result of occult choroidal neovascular membrane in nine (82%) of 11 eyes but no well-defined choroidal neovascular membrane. CONCLUSIONS: Indocyanine green angiography is superior to fluorescein angiography for imaging choroidal neovascularization in cases of retinal pigment epithelium tear and may serve as an important adjunct to indocyanine green-guided laser treatment in selected cases.     

ICG angiography-guided photodynamic therapy for large pigment epithelial detachments in age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To evaluate the role of photodynamic therapy (PDT) in the management of vascularized pigment epithelial detachment in age-related macular degeneration (AMD) when the pigment epithelial detachment is the predominant component of the neovascular complex. PATIENTS AND METHODS: Seventeen eyes of 17 patients underwent indocyanine green angiography-guided PDT and had at least 6 months of follow-up. Data retrieved included visual acuity and angiographic features prior to the treatment, number of PDT sessions, visual acuity, angiographic outcomes at the end of the follow-up, length of follow-up, and status of the fellow eye. in the series, with an average age of 77 years and a mean follow-up time of 11 months. Six (35%) of the patients lost less than 3 lines of visual acuity, 6 (35%) lost between 3 and 6 lines, and 5 (30%) lost 6 or more lines. Angiographic outcomes were categorized as failures in 14 (82%) of the treated eyes and successful in 3 (17%) eyes. CONCLUSIONS: In 82% of the eyes, PDT failed to flatten the pigment epithelial detachment or prevent growth of the choroidal neovascular membrane. Visual acuity outcomes correlated poorly with angiographic outcomes. PDT does not seem to improve the prognosis of eyes with large pigment epithelial detachments in AMD.     

Preoperative factors influencing visual acuity following vitrectomy for exudative age-related macular degeneration

PURPOSE: We investigated the relations between ingrowth site and visual results in patients undergoing surgical removal of subfoveal choroidal neovascular membranes (CNV) caused by age-related macular degeneration (AMD). MATERIALS AND METHODS: The subjects were 70 eyes(69 patients), which underwent surgical removal of CNV for AMD and were followed up for 6 months or more. The eligibility criteria were active subfoveal choroidal neovascular membrane 3 disc diameters (DD) or less in size located above the retinal pigment epithelium, and visual acuity of 0.3 or worse. We analyzed the relationships between postoperative best-corrected visual acuity and preoperative factors: ingrowth site of CNV, distance between the fovea and the CNV edge, CNV size, and fluorescence pattern in indocyanine green angiography (IA). RESULTS: Patients 1) with feeder vessels located outside the foveal avascular zone (FAZ) rather than inside the FAZ and/or unknown feeder vessels, 2) with a distance between the fovea and the CNV edge 0.2 DD or less than 0.2 DD versus larger, than 0.2 DD 3) with a 1 DD or smaller CNV versus 1.5 DD or larger, and 4) type I, II, or III findings in IA rather than type IV had good postoperative best-corrected visual acuity. CONCLUSIONS: To achieve better postoperative visual acuity after surgical removal of CNV associated with AMD, it is important to select CNV with ingrowth sites outside the FAZ, small and large CNV with a relatively short distance between the fovea and the CNV edge closest to the fovea, and type I, II, and III findings in IA.     

Clinical application of indocyanine green angiography to choroidal neovascularization

In order to evaluate the clinical usefulness of indocyanine green video-angiography (IA), the angiographic features of choroidal neovascular membranes (CNM) were investigated in 27 eyes with choroidal neovascular diseases by means of standard fluorescein angiography (FA) and IA. FA showed the existence of CNM in 21 eyes and IA demonstrated evidence of CNM in 19 eyes, as "fan, comb or spotty hyperfluorescence" in the early stage and "leakage" in the late stage. In 6 out of 19 eyes the existence of CNM was shown by IA, while FA failed to identify the precise location and size of CNM due to the masking effect of overlying turbid fluid, massive hemorrhage or a large amount of serous fluid. The results imply that IA has an advantage over FA in cases where FA shows only the sign of occult choroidal neovascularization, and that IA can be applied to neovascular maculopathy as a routine examination.     

Indocyanine green guided laser photocoagulation in patients with occult choroidal neovascularisation

AIMS: To determine whether indocyanine green (ICG) guided laser photocoagulation of occult choroidal neovascularisations (OCNV) is beneficial for patients with occult choroidal neovascularisation secondary to age related macular degeneration (AMD). METHODS: A prospective pilot study was performed in 21 eyes with OCNV secondary to AMD that could be identified extrafoveolarly or juxtafoveolarly in an early ICG angiographic study. Laser photocoagulation was applied to the neovascular membrane identified in the early ICG angiographic study. RESULTS: Visual acuity ranged from 20/400 to 20/20 (logMAR 0.54 (SD 0.29) before and hand movements and 20/30 (logMAR 0.81 (0.69)) at the last follow up after laser photocoagulation. During the follow up (30 (13) months) vision improved in four eyes (two lines), in seven eyes the initial visual acuity could be stabilised (two lines), in five eyes vision dropped moderately (three to five lines), and in five eyes vision decreased severely (six or more lines). Recurrences (seven patients) or persistent CNV (six patients) was observed in 13 patients. CONCLUSION: This preliminary study of ICG guided laser photocoagulation of occult extrafoveal and juxtafoveal choroidal neovascularisations suggests that this technique may improve the visual prognosis of these patients. Further prospective controlled studies are necessary to confirm these data.     

Ocular photodynamic therapy in choroidal neovascularization complicating idiopathic central serous chorioretinopathy.

Two consecutive patients with idiopathic central serous chorioretinopathy and decreased vision subsequent to subfoveal choroidal neovascular membranes were treated with photodynamic therapy applied using the protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and leakage on fluorescein and indocyanine green angiography. Photodynamic therapy offered anatomical, angiographic, and functional improvement. After an initial complete response, the patients required re-treatment at 3 and 4 months, respectively. Cessation of leakage with improvement in visual acuity occurred, but subretinal fibrosis posed a possible limitation for full functional recovery. Although choroidal neovascular membranes complicating idiopathic central serous chorioretinopathy portend a poor visual prognosis, the overall response to photodynamic therapy was favorable.     

Confocal scanning laser microscopic findings of excised choroidal neovascular membranes of age-related macular degeneration and their comparison with the clinical features

PURPOSE: To evaluate the histopathological characteristics of choroidal neovascular membranes excised from eyes of patients with age-related macular degeneration (AMD) and to correlate their characteristics with the clinical features of AMD. METHODS: Choroidal neovascular tissues were excised from 3 patients with AMD and examined by light and confocal scanning laser microscopy. The clinical features were obtained by fundus photography, fluorescein angiography (FA), and indocyanine green angiography (IA) and compared with the histopathological findings. RESULTS: Light microscopy showed the presence around the vascular structures of cells containing pigment. Confocal scanning laser microscopy revealed lipofuscin signals of the retinal pigment epithelium cells around the vascular tissue that was also confirmed by three-dimensional reconstructed views from serial optical sections. Clinical observations of the fundus by IA showed that all 3 cases had areas with hyperfluorescence in early phase on IA. A dark rim was observed around the area of hyperfluorescence in 2 cases, and the dark rim was located within the neovascular membrane. The patterns of fluorescence were heterogeneous in some phases on IA, which reflected the histological heterogeneity of the neovascular membrane. CONCLUSIONS: The retinal pigment epithelium cells appear to play a special role in the induction and regression of the choroidal neovascular membrane associated with age-related macular degeneration.     

Comparison with indocyanine green angiography and immunohistochemical study of choroidal neovascular membrane in age-related macular degeneration

PURPOSE: We classified choroidal neovascular membranes (CNMs) (48 eyes) in age-related macular degeneration (AMD) into four types using indocyanine green angiography. METHODS: Surgically extracted CNMs were examined immunohistochemically. Specimens were stained with glial fibrillary acidic protein (GFAP), von Willebrand factor, Ki-67 antigen, actin, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), and transforming growth factor (TGF-beta 1). RESULTS: All types of CNM were positively stained with GFAP on the side opposite the retinal pigment epithelial (RPE) cells. This suggests the adherence of neurosensory retina to the CNM. Type I membranes which showed hyperfluorescence in the early and late phase of ICG angiography were significantly stained with Ki-67 antigen. CONCLUSION: These results indicate that CNMs in AMD are extracted with neurosensory retina and RPE cells during surgery. Type I membranes have a high capability for proliferation.     

Surgical excision versus laser photocoagulation for subfoveal choroidal neovascular membrane with age-related macular degeneration: comparison of visual outcomes

PURPOSE: This study was designed to compare visual acuity after laser photocoagulation with visual acuity after surgical excision of the subfoveal choroidal neovascular membrane in patients with age-related macular degeneration (AMD). METHODS: We studied 54 patients (56 eyes) who underwent laser photocoagulation and 52 patients (52 eyes) who underwent surgical excision for new subfoveal choroidal neovascular membrane occurring with AMD. We compared mean log of minimal angle of resolution (MAR) visual acuity, and the percentages of eyes showing visual improvement and a visual acuity of 0.1 or better, between the two treatment groups at 12 months after treatment. The groups were also compared according to choroidal neovascular membrane size, ie, 1 disc diameter (DD) or smaller vs larger than 1 DD. RESULTS: Mean corrected visual acuity (P <.01), percentage of eyes with improved vision (P <.01), and percentage with a visual acuity of at least 0.1 (P <.01) were higher in surgically treated eyes. The differences in mean log MAR visual acuity and the percentages were significant only for choroidal neovascular membrane of one DD or less in size. CONCLUSIONS: Postoperative eyes, especially those with choroidal neovascular membranes 1 DD or less in size, had better visual outcomes. Patients who meet our eligibility criteria, especially with small choroidal neovascular membranes 1 DD or less in size, should undergo surgical excision.     

Hyperfluorescence associated with serous retinal pigment epithelial detachment on indocyanine green angiography

PURPOSE: Indocyanine green angiography has been reported to improve detection and delineation of occult choroidal neovascularisation in serous pigment epithelium detachment in age-related macular degeneration. The study aims to evaluate the visual acuity results of eyes affected by serous pigment epithelium detachment in age-related macular degeneration, having had indocyanine green-directed laser photocoagulation, and to correlate them to the pattern of serous pigment epithelium detachment on indocyanine green angiography. METHODS: Thirty-four eyes of 31 patients affected by serous pigment epithelium detachment in age-related macular degeneration were prospectively considered. Each patient underwent an ophthalmological examination including fluorescein and indocyanine green angiography one day before, and 6 weeks, 3 months, 6 months, 9 months, 12 months and 24 months after krypton-laser treatment. The serous pigment epithelium detachment was classified in the late-phases angiograms as either hypofluorescent, isofluorescent or hyperfluorescent comparing the fluorescence of the serous pigment epithelium detachment with the choroidal background fluorescence. RESULTS: The indocyanine green-guided laser treatment was associated with a temporary stabilization and a long-term progressive reduction of visual acuity: after 24 months visual acuity improved in 2.9%, stabilized in 26.5% and worsened in 70.5% of cases. Serous pigment epithelium detachment presenting a pretreatment hyperfluorescence had a final visual acuity of 0.06, with subfoveal choroidal neovascularisation development in 100% of cases, whereas serous pigment epithelium detachment presenting a pretreatment hypofluorescence and isofluorescence showed a final visual acuity of 0.12, with subfoveal choroidal neovascularisation development in 43.5% of eyes, with statistically significant difference. CONCLUSION: Overall visual acuity decreases with time after indocyanine green-guided laser treatment of choroidal neovascularisation in serous pigment epithelium detachment, and serous pigment epithelium detachment becoming hyperfluorescent in the late-phases of indocyanine green angiography has the worst functional outcome.