Indocyanine green angiographic features in ocular sarcoidosis

ObjectiveTo determine indocyanine green (ICG) angiographic features and evaluate the extent of choroidal involvement in proven cases of posterior ocular sarcoidosis.DesignNonrandomized controlled trial.ParticipantsNineteen patients (14 females, 5 males; average age, 56 ± 4 years) with clinically typical posterior sarcoidosis (biopsy-proven in 6 cases and fulfilling the other diagnostic criteria in 13 cases) participated, with 10 control subjects (average age, 48 ± 7 years). Criteria for the diagnosis of sarcoidosis were a positive biopsy result or the presence of at least three of the following four criteria: elevated serum angiotensin-converting enzyme, elevated lysozyme, cutaneous anergy, and hilar lymph node enlargement.InterventionIndocyanine green angiography was performed according to a standard angiographic protocol used in inflammatory disorders.Main outcome measuresIndocyanine green angiographic features and proportion of choroidal inflammatory involvement were measured.ResultsIndocyanine green angiographic features could be classified into four main patterns. The first pattern is hypofluorescent choroidal lesions in the early and intermediate phases, irregularly distributed, invisible on funduscopy or fluorescein angiography, and localized in the midperiphery (63% of patients), in the macula (11%) or in both regions (26%) with an average dot diameter of 0.31 ± 0.03 disc diameters. These lesions either became isofluorescent in the late phase of the angiogram (Type 1, present in all patients) or remained hypofluorescent (Type 2, present in 84% of patients). The second pattern is focal hyperfluorescent pinpoints visible in the intermediate and late phases (in 89% of patients). The third pattern is fuzzy choroidal vessels with leakage in the intermediate phase of the angiogram, and the fourth pattern is diffuse late zonal choroidal hyperfluorescence with staining in the late phase of the angiogram, both features being present in all patients.ConclusionsIndocyanine green angiography allowed the authors to assess and quantify the hitherto unknown extent of choroidal involvement in ocular sarcoidosis. Furthermore, characteristic ICG findings might represent an additional valuable tool for diagnosing and monitoring this disease.     

Indocyanine green angiographic features in endogenous Candida chorioretinis

BACKGROUND: To describe indocyanine green (ICG) angiography (ICGA) findings and clinical features of endogenous mycotic endophthalmitis. PATIENTS AND METHODS: Two patients (a female 62 years, a male 31 years) were addressed to investigate a progressive unilateral visual loss. Slit-lamp examination disclosed a macular chorioretinitis. A clinical work-up revealed a mycotic infection (Candida albicans). Before treatment an ICGA was performed. RESULTS: ICGA early frames disclosed hypofluorescent lesions. Progressively, the lesions were surrounded by a slight hyperfluorescence, although the centre of the lesions was still hypofluorescent. CONCLUSIONS: The presence and persistence of a hypofluorescent lesion after introducing a specific treatment, led us to suspect a necrotic/ischaemic process affecting the choroidal vascular bed. ICGA provided additional information regarding the pathophysiological process and the patient's functional visual recovery.     

Indocyanine green angiographic features of varix of the vortex vein ampulla

Varix of the vortex vein ampulla is a rare, benign, asymptomatic condition, which may be confused with a choroidal naevus or melanoma. A 28-year-old man was referred to a tertiary retinal practice with a diagnosis of choroidal naevus. The lesion was an elevated choroidal mass in the superonasal peripheral retina measuring 2 by 1 disc diameters. It was dark red to burgundy in colour and disappeared under digital pressure applied to the globe. The methods used in diagnosis were colour fundus photography, fluorescein angiography and indocyanine green angiography using a scanning laser ophthalmoscope. On fluorescein angiography the lesion was initially hypofluorescent, becoming isofluorescent 25 s after dye injection. Indocyanine green angiography demonstrated the lesion to be two separate dilatations of the vortex vein ampullae. The dilatations collapsed when pressure was applied to the globe. A choroidal mass that collapses under pressure applied to the globe should suggest a varix of the vortex vein ampulla. Indocyanine green angiography is useful in demonstrating the outline of the varix of the vortex vein ampulla.     

原田病的吲哚青绿血管造影特征

目的 探讨原田(Harada)病的吲哚青绿血管造影(indocyanine green angiography,ICGA)特征。 方法 对26例经荧光素眼底血管造影(fundus fluorescien angiography,FFA)确诊的Harada病患者26例52只眼同时进行ICGA检查。 结果 Harada病的主要ICGA表现为：①早期异常暗的背景荧光5例8只眼;②脉络膜灌注不良12例18只眼;③脉络膜血管及涡静脉扩张20例34只眼;④晚期斑片状强荧光8例12只眼;⑤中周及后极部斑点状弱荧光4例5只眼。 结论 Harada病ICGA特征：早期异常暗的背景荧光,脉络膜灌注不良,脉络膜血管及涡静脉扩张,中周及后极部斑片状弱荧光,晚期可见斑片状强荧光。(中华眼底病杂志,2000,16:12-13)     

Indocyanine green angiographic findings in sympathetic ophthalmia

· Purpose: To analyze indocyanine green angiography (ICGA) features in two cases of sympathetic ophthalmia using a standard angiography protocol for posterior uveitis. · Methods: Report on two patients who suffered from penetrating ocular injuries 45 and 8 years before sympathetic ophthalmia was diagnosed and confirmed by histopathological examination of the enucleated eye. In addition to routine examination and fluorescein angiography, initial and follow-up ICGAs were performed. · Results: The first patient, with a phthisic right eye following s shotgun injury, consulted 6 months after cataract extraction in his good left eye for progressive visual loss due to a neovascular membrane in a moderately inflamed eye. The second patient consulted 8 years after a perforating injury of his right eye by a metallic foreign body because of recent visual loss and inflammation in his good left eye. ICGA of both patients showed numerous hypofluorescent dark dots visible at the intermediate phase, some becoming isofluorescent at the late phase and resolving after long-term corticosteroid therapy, others remaining hypofluorescent until the late phase. · Conclusion: The two patterns of hypofluorescent areas, either persisting throughout angiography or fading in the late phase, were interpreted respectively as cicatricial and active lesions. ICGA gave determining additional information on choroidal involvement and on subsequent evolution of lesions. Received: 8 September 1997 Accepted: 8 December 1997     

Indocyanine green angiographic findings of chorioretinal folds

PURPOSE: To analyze indocyanine green (ICG) angiographic findings of chorioretinal folds. METHODS: Eight patients (9 eyes) in whom chorioretinal folds had been diagnosed were enrolled in this study. Color photography, fluorescein angiography (FA) and ICG angiography (IA) were performed. RESULTS: Indocyanine green angiography demonstrated choroidal venous congestion and a filling delay of the choroidal vessels in one case with an orbital tumor. In one posterior scleritis case, IA showed a filling delay of choroidal vessels in the early phase and multiple patchy hypofluorescent lesions scattered in the posterior pole during the late phase. Idiopathic cases showed choroidal venous dilatation. No abnormalities of the choroidal vasculature in the form of radial folds, were revealed in two cases of AMD. Linear hyperfluorescent areas suggestive of chorioretinal folds seen on IA were less numerous and wider than those observed on FA in some eyes. On the other hand, they were equally numerous and wider on IA than those on FA in other eyes. CONCLUSION: Indocyanine green angiography is useful for evaluating both pathological conditions of the choroidal vasculature and the width of chorioretinal folds at the level of the choroidal vasculature.     

Indocyanine green angiographic findings in serpiginous choroidopathy.

AIMS--Analysis of the choroidal findings in patients affected by serpiginous choroidopathy (SC). METHODS--Thirteen patients (23 eyes; 11 males and two females; age range 50-68 years; mean age 59.1 years) affected by SC were examined with fluorescein angiography (FA) and indocyanine green angiography (ICGA). The follow up period was 7-33 months. RESULTS--Using ICGA the disease could be divided into the following stages: (1) subclinical or choroidal stage (hypofluorescent lesions without FA evidence); (2) active stage (with ICGA and FA evidence); (3) subhealing stage (slight late hyperfluorescent lesions with ICGA, with no evidence on FA); (4) inactive or healed stage (hypofluorescent areas with ICGA and hyperfluorescent areas with FA). CONCLUSIONS--Although FA showed a clear distinction between active and healed stages, ICGA allowed a greater subdivision of the disease. In particular, ICGA allowed: (1) better staging of SC, revealing choroidal alterations when there was no ophthalmoscopic or FA evidence; (2) better identification of the active lesions which appear to be larger at the choroidal level in comparison with the corresponding retinal lesions; and (3) revealed a persistence of choroidal activity even when the signs of retinal activity had disappeared. Thus, ICGA should be a particularly useful clinical and therapeutic monitoring tool of SC.     

Indocyanine green angiographic findings in central serous chorioretinopathy

There has been great controversy about the pathogenesis of the focal changes in the retinal pigment epithelium (RPE) causing detachment of the neurosensory retina in central serous chorioretinopathy (CSC). This study was performed to evaluate changes in choroidal perfusion in 15 patients with CSC. Fluorescein and indocyanine green (ICG) angiography was performed in patients with acute or chronic recurrent CSC. In all patients delayed arterial filling followed by capillary and/or venous congestion, in some cases adjacent to ischemic areas, was found in the choroid. Leakage from the RPE in fluorescein angiography was only observed in those areas with choroidal capillary and/or venous congestion. The preliminary results suggest that venous congestion possibly in association with ischemia causes hyperpermeability of choroidal vessels already described in the literature.     

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 presumed intraocular tuberculosis

PurposeTo study features of Indocyanine green angiography (ICGA) in patients with presumed intraocular tuberculosis.MethodsRetrospective study of 48 consecutive patients (77 eyes) who underwent ICGA. The following signs were analysed: choroidal perfusion inhomogeneity, early hyperfluorescent stromal vessels, round or oval hypofluorescent dark dots (HDDs), hypofluorescent geographic lesions (HGLs), fuzzy or lost pattern of large stromal choroidal vessels, disc hyperfluorescence and diffuse late choroidal hyperfluorescence.ResultsAmong 44 eyes of 29 patients with no clinical evidence of choroidal involvement, only 7 eyes of 6 patients had no ICGA evidence of choroidal involvement. On the other hand, ICGA findings suggesting choroidal involvement were noted in 37 (84.1%) eyes of 23 patients in the form of HDDs in all 37 (100%) eyes, HGLs in 7 (18.9%) eyes, disc hyperfluorescence in 20 (45.5%) eyes, fuzzy stromal vessels in 17 (38.6%) eyes, early hyperfluorescent stromal vessels in 13 (29.5%) eyes, late pinpoint hyperfluorescence in 11 (25%) eyes and late diffuse choroidal hyperfluorescence in 7 (15.9%) eyes. Among 33 eyes of 19 patients with clinically evident choroidal involvement, the following findings were identified; HDDs in 12 (36.4%) eyes, HGLs in 10 (30.3%) eyes, both HDDs and HGLs in 9 (27.3%) eyes, disc hyperfluorescence in 11 (33.3%) eyes, early hyperfluorescent stromal vessels in 7 (21.2%) eyes, fuzzy stromal vessels in 6 (18.2%) eyes and late diffuse choroidal hyperfluorescence was present in 2 (6.1%) eyes.ConclusionsICGA is necessary in identifying and diagnosing subclinical tuberculous choroidal involvement. The most prevalent ICGA finding was persistent HDDs.Subject terms: Tomography, Outcomes research     

Indocyanine green angiographic findings in acute retinal necrosis

PURPOSE: To clarify indocyanine green (IA) angiographic features in patients with acute retinal necrosis (ARN). METHODS: Two patients with ARN were examined by fluorescein angiography (FA) and IA, and findings from both were compared. RESULTS: Fundus examination revealed widespread retinal hemorrhages and yellowish-white patches in the periphery, characteristic of ARN. In both cases, FA showed diffuse dye leakage from all retinal veins and the optic disc, and vascular obstruction in the peripheral fundus. In IA, dye leakage was localized, and extravasation of dye was evident only from the lower temporal retinal vein and the lower half of the optic disc. This pattern of indocyanine green dye leakage appeared to be continuous from the optic disc toward the lower temporal retinal vein. Also, IA clearly demonstrated choroidal vascular filling delay in one case in the early phase of the angiogram. CONCLUSIONS: While FA showed diffuse dye leakage from all retinal veins, IA identified only the retinal vessels with the most prominent vascular damage. IA also identified choroidal vascular lesions in these patients with ARN. The information obtained by IA might be useful to detect retinal vasculitis with prominent inflammation and to determine the extent of choroidal inflammation in patients with ARN.     

Indocyanine green angiographic features of systemic non-Hodgkin's lymphoma and bilateral choroidal involvement.

A 35-year-old man with systemic non-Hodgkin's lymphoma and bilateral choroidal involvement is described. Indocyanine green angiography depicts choroidal involvement much better than fluorescein angiography and seems to be superior in diagnosing and monitoring patients with systemic non-Hodgkin's lymphoma and choroidal involvement.     

Indocyanine green angiographic findings in systemic lupus erythematosus choroidopathy

PURPOSE: To report two patients affected with systemic lupus erythematosus choroidopathy studied with combined fluorescein angiography and indocyanine green angiography. In particular, the presence of choroidal abnormalities at indocyanine green angiography, which could not be detected by fluorescein angiography, was studied. DESIGN: Observational case reports. METHODS: Retrospective review of the clinical and photographic records of two patients with systemic lupus erythematosus in whom choroidopathy developed. RESULTS: Four findings were unveiled by indocyanine green angiography: focal, transient hypofluorescent areas in the very early phase; fuzziness of large choroidal vessels with late diffuse zonal choroidal hyperfluorescence; poorly-defined areas of choroidal hypofluorescence visible up to the late phase; and focal cluster of pinpoint spots of choroidal hyperfluorescence visible from the intermediate to late phase. CONCLUSION: Indocyanine green angiography can provide information that is not detectable by clinical or fluorescein angiographic examination in patients with systemic lupus erythematosus choroidopathy. This information may prove useful in better understanding the pathogenesis of systemic lupus erythematosus choroidopathy.     

Indocyanine green angiographic features of choroidal rupture and choroidal vascular injury after contusion ocular injury

PURPOSE: To report features of choroidal rupture and choroidal vascular injury after contusion ocular injury on indocyanine green angiography. METHODS: In a prospective study, nine patients (nine eyes) with choroidal rupture after ocular contusion underwent initial fluorescein angiography and indocyanine green angiography within 19 days after trauma. Eyes that had a distinct abnormality of the retinal pigment epithelium were excluded from this study. Subtraction indocyanine green angiography was also performed. Follow-up fluorescein angiographic and indocyanine green angiographic findings were also studied. RESULTS: Initial ophthalmoscopic examination revealed subretinal hemorrhage in all nine eyes. In five of the nine eyes, choroidal rupture was not seen on initial ophthalmoscopic or fluorescein angiographic examination because it was hidden beneath the subretinal hemorrhage, but it was detected on subsequent examinations. In the remaining four eyes, choroidal rupture was observed by ophthalmoscopy at the time of initial examination, and these eyes exhibited hyperfluorescent streaks on fluorescein angiography in the region of the subretinal hemorrhage. On initial indocyanine green angiography of all nine eyes, observed hypofluorescent streaks became more obvious with time. For each eye, there were more hypofluorescent streaks on indocyanine green angiography than hyperfluorescent streaks on fluorescein angiography. In one eye, the location of indocyanine green leakage nearly coincided with the location of a hyperfluorescent streak on fluorescein angiography. In this case, crescentic streaks of hypofluorescence were seen on the temporal side of the subretinal hemorrhage on indocyanine green angiography, although choroidal rupture was not observed in that region by ophthalmoscopy or fluorescein angiography. In two of the nine eyes, indocyanine green angiography and the subtraction technique demonstrated disturbance of flow into choroidal vessels, especially at the choroidal rupture site. CONCLUSION: After ocular contusion injury, various features of choroidal rupture and choroidal vascular injury were observed on indocyanine green angiography. This technique may contribute to the diagnosis of choroidal rupture and to the understanding of the clinical course after injury.     

Indocyanine green angiography features in toxoplasmic retinochoroiditis

BACKGROUND: Indocyanine green (ICG) angiography detects the infrared fluorescence of ICG through the retinal pigment epithelium, providing visualization of the choroidal vascular network. The aim of this study was to analyze ICG angiographic features in toxoplasmic retinochoroiditis. METHODS: Indocyanine green angiography was performed according to a standard uveitis angiographic protocol in 28 consecutive patients diagnosed with acute toxoplasmic retinochoroiditis. Indocyanine green angiographic data were compared with fundus color photographs and fluorescein angiography (FA). Evolution of ICG angiographic signs after therapy (pyrimethamine and sulfadiazine with or without a tapering course of oral corticosteroids) was further analyzed. RESULTS: The main focus of retinochoroiditis was hypofluorescent at all phases of the ICG angiogram in 25/28 cases (89%), but late phase (35-45 minutes) ICG hyperfluorescence was seen in three cases, all of which had very superficial retinal involvement. The most striking features, however, were multiple hypofluorescent satellite dark dots (SDD), present in 21/28 cases (75%). In 17 of these 21 patients, hypofluorescent areas were silent on FA and fundus examination. After therapy, SDD disappeared from most of the cases. Furthermore, the hypofluorescence under the main lesion was markedly reduced or disappeared in some cases. CONCLUSIONS: Indocyanine green angiography showed that toxoplasmic retinochoroiditis is a more widespread process than is clinically suspected because it extends beyond the visible lesions. Indocyanine green angiography appears useful in assessing the extent of choroidal involvement and the evolution of lesions. It might become an important follow-up parameter and also may give new insights into the pathophysiology of this disease. Based on the findings gathered so far, ICG angiography appears indicated in the workup and management of toxoplasmic retinochoroiditis.     

Indocyanine green angiographic findings of obscure choroidal abnormalities in neurofibromatosis

We report two cases of choroidal neurofibromatosis, detected with the aid of indocyanine green angiography (ICGA) in patients with neurofibromatosis (NF)-1, otherwise having obscure findings based on ophthalmoscopy and fluoresceine angiography (FA). In case 1, the ophthalmoscopic exam showed diffuse bright or yellowish patched areas with irregular and blunt borders at the posterior pole. The FA showed multiple hyperfluorescent areas at the posterior pole in the early phase, which then showed more hyperfluorescence without leakage or extent in the late phase. The ICGA showed diffuse hypofluorescent areas in both the early and late phases, and the deep choroidal vessels were also visible. In case 2, the fundus showed no abnormal findings, and the FA showed weakly hypofluorescent areas with indefinite borders in both eyes. With the ICGA, these areas were more hypofluorescent and had clear borders. Choroidal involvement in NF-1 seems to occur more than expected. In selected cases, ICGA is a useful tool to be utilized when an ocular examination is conducted in a patient that has no definite findings based on the ophthalmoscope, B-scan, or FA tests.     

Indocyanine green angiographic findings of Dalen-Fuchs nodules in Vogt-Koyanagi-Harada disease

Purpose The purpose of this study was to analyze indocyanine green (ICG) angiographic findings of Dalen-Fuchs nodules in Vogt-Koyanagi-Harada (VKH) disease. Methods ICG angiograms of 15 patients (30 eyes) with Dalen-Fuchs nodules in VKH disease of between 2 months and 5 years after the initial diagnosis were retrospectively studied. Findings of ICG angiography were compared with features of fundus fluorescein angiography (FFA). Results Dalen-Fuchs nodules were easily found in the inferior (30 eyes, 100%) and temporal periphery (22 eyes, 73%) and showed two kinds of fluorescence in ICG angiography. In ten patients (20 eyes), the nodules showed small round hypofluorescent dark dots in the whole process of angiography, and the dark dots were larger in size than the nodules in FFA. Disease course in these patients was relatively long—between 1 year and 5 years. On clinical examination, the nodules were atrophic, and hyperpigmentation was found around them. In another five patients (ten eyes), parts of the nodules showed small hyperfluorescent dots in the early phase, but they were faint in the intermediate phase and became large, hypofluorescent dark dots in the late phase. Disease course in these patients was between 2 and 8 months. The nodules were bright yellow, fresh, and much larger than those in the first kind of ICG fluorescence. Conclusions Dalen-Fuchs nodules in VKH are mostly present in the inferior and temporal periphery. The two kinds of fluorescence of Dalen-Fuchs in ICG angiography may reflect obliteration of choriocapillaris under the nodules and different quantities of lipofuscin in the nodules at different time points of the disease.