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Indocyanine Green Angiography (indocyanine + green_angiography)
Selected Abstracts2255: Inflammatory neovascular membraneACTA OPHTHALMOLOGICA, Issue 2010P NERI Purpose To describe the most common mistakes in the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially sight-threatening sequela of uveitis. Several mistakes can be done during patients examination: CNV might not be recognized both at biomicroscopy and at fluorescein angiography (FA), for instance. Moreover, since some doctors are not aware of the importance of Indocyanine Green Angiography (ICGA), the choroidal involvement during inflammatory CNV might not be appreciated. These are just some examples of possible errors which can be done during the daily practice. The outcome of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. The most important mistake can be represented by the lack of criticism on the treatment techniques: several methods have been proposed, albeit some of them should not be used on the basis of the treatment rationale and on the better knowledge of CNV pathophysiology. The presentation shows the most typical cases where the above mentioned mistakes have been done, suggesting some methods in order to avoid them. Conclusion CNV secondary to uveitis is a severe sequela, which can lead to significant visual impairment. Several mistakes can be done during both the diagnosis and the therapeutic procedures. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy. [source] Progress in the appraisal and management of inflammatory CNVsACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the progress in the appraisal and the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially severe sequela of posterior uveitis. The role of chronic inflammation has been described in experimental uveitis. For such reasons, even when biomicroscopy and fluorangiography (FA) cannot detect abnormalities, Indocyanine Green Angiography (ICGA) can show choridal anomalies. ICGA greatly improved the appraisal of the choroidal involvement, by providing reliable data for the diagnosis and for the management of inflammatory CNV. The new spectral domain optical coherence tomography (OCT) equipments can provide further informations that can be useful for a correct clinical assessment. The out-come of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. Steroids, both local and systemic, are the first line therapy for non-infectious choroidal inflammation, although their long-term use can lead to unpleasant sequala, such as glaucoma and cataract. Immunesuppressive agents, lasers photocoagulation, photodynamic treatment, surgical removal and anti-Vascular Endothelial Growth Fact (VEGF) are other options. Conclusion CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant informations about the choroidal status. Several therapeutic options have been considered, but no guidelines are available at the moment. [source] Monitoring free flaps using laser-induced fluorescence of indocyanine green: A preliminary experienceMICROSURGERY, Issue 7 2002C. Holm M.D. In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:278,287 2002 [source] Clinical features and follow-up results of pulsating polypoidal choroidal vasculopathy treated with photodynamic therapyACTA OPHTHALMOLOGICA, Issue 6 2010Suk Ho Byeon Acta Ophthalmol. 2010: 88: 660,668 Abstract. Purpose:, To report on the clinical course of pulsating polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT). Methods:, A total of 63 eyes of 58 consecutive patients diagnosed with PCV, treated with PDT and followed up for at least 6 months were enrolled. Best-corrected visual acuity (BCVA), fluorescein angiography and high-speed indocyanine green angiography (ICGA) using confocal scanning laser ophthalmoscopy (HRA) were performed. Results:, Of the 63 PCV eyes, 14 eyes (22.2%) of 14 patients were classified as having pulsating PCV. The mean age of pulsating PCV patients was 60.6 ± 7.0 years (48,69 years), which was younger than non-pulsating PCV patients (65.7 years, p = 0.035). The mean follow-up period was 23.9 ± 10.7 months, and PDT was administered 1.6 ± 0.9 times to pulsating PCV patients. The mean logMAR BCVAs were 0.85 ± 0.47 at presentation and 0.71 ± 0.52 at final examination. Extensive haemorrhagic events were more common in pulsating than in non-pulsating PCV patients (57.1% versus 26.5%, p = 0.032). However, the risk of haemorrhage within 3 months of PDT was similar for both pulsating PCV and the remaining patients (14.3% versus 20%, p = 0.723). Conclusion:, Pulsating PCV showed distinctive features including a relatively younger patient age at presentation, and a haemorrhagic tendency (especially extensive). However, the use of PDT did not directly increase the risk of haemorrhage in pulsating PCV patients. [source] 4366: Treatment of choroidal neovascularization associated with choroidal nevusACTA OPHTHALMOLOGICA, Issue 2010E PILOTTO Purpose Purpose:To evaluate safety and efficacy of different treatments of choroidal neovascularization (CNV) associated with choroidal nevus at the posterior pole. Methods Methods: Six patients affected by choriodal nevus complicated by CNV were treated with photodynamic therapy with verteporfin (PDT; 50 J/cm2, 83 seconds) (five cases), or intravitreal anti-VEGF (bevacizumab, 1.25 mg) (one case). All patients underwent an ophthalmologic evaluation, including fluorescein and indocyanine green angiography, A-and B scan ultrasonography and OCT at presentation and at each follow-up examination. CNV was extrafoveal in all PDT treated cases, and a foveal serous detachment was detectable. CNV was subfoveal in the eye treated with anti-VEGF. Results Results: Mean follow-up was 15.5 months (range: 6 , 24). Visual acuity improved in four of the PDT treated cases and in the anti-VEGF treated eye, while it remained unchanged in the remaining PDT treated lesion. In all eyes resolution of the foveal serous detachment was detectable. In all PDT treated eyes a single treatment was performed with no recurrence during follow-up. Meanwhile anti-VEGF was repeated after three months for CNV recurrence. Conclusion Conclusions: PDT and anti-VEGF seem both effective in the treatment of CNV secondary to choroidal nevus but a larger study is required to evaluate long-term efficacy and safety expecially of anti-VEGF therapy. [source] Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 4 2010Christina Frennesson Abstract. Purpose:, To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). Methods:, The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69,95 years). In addition to a full ophthalmological examination , including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography , near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. Results:, Mean BCVA increased from 62 ± 11 to 66 ± 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 ± 5 to 6 ± 3 points (33%; p = 0.0006) and reading speed increased from 59 ± 40 to 85 ± 50 words/min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from ,9 ± 7 to ,6 ± 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 ± 28 to 63 ± 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 ± 26 to 63 ± 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. Conclusion:, The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously. [source] Unilateral choroidal excavation in the macula detected by spectral-domain optical coherence tomographyACTA OPHTHALMOLOGICA, Issue 3 2010Yuka Wakabayashi Abstract. Purpose:, To report clinical findings of three patients with unilateral peculiar choroidal excavation in the macula detected by spectral-domain (SD) optical coherence tomography (OCT). Methods:, Three cases with unilateral choroidal excavation in the macula detected by SD OCT. Fluorescein angiography (FA), indocyanine green angiography (IA), ultrasonography, visual field tests and multifocal electroretinography (mfERG) were performed. Results:, Although all three patients complained of metamorphopsia, visual acuity and central visual field were normal in the affected eyes. SD OCT demonstrated choroidal excavation in the macula despite a normal foveal contour along the inner retinal surface. The excavation involved the outer retinal layers up to the external limiting membrane in cases 1 and 2, while only the retinal pigment epithelium was involved in case 3. The excavation corresponded to foveal pigment mottling in cases 1 and 2 and to a parafoveal yellowish fusiform lesion in case 3. The lesions appeared hypoautofluorescent and unremarkable in FA except for circumferential hyperfluorescence in case 3 and hypofluorescent in IA. B-scan ultrasonography was unremarkable. MfERG in cases 1 and 2 was normal. Conclusions:, SD OCT demonstrated two types of choroidal excavation in the macula. More case accumulation and a longer follow-up will elucidate the pathogenesis and prognosis of the lesions. [source] Three-dimensional angiographic imaging of leakage in branch retinal vein occlusionACTA OPHTHALMOLOGICA, Issue 2 2010Ursula Margarethe Schmidt-Erfurth Abstract. Purpose:, Optical coherence tomography (OCT) is used to image branch retinal vein occlusion (BRVO) but lacks information about leakage dynamics and perfusion status. Topographical angiography (TAG) is capable of providing this information and has been described previously in age-related macular degeneration. This study evaluates TAG in BRVO. Methods:, We included 56 eyes of 40 consecutive patients with BRVO and a reduction in central vision. Two groups were established based on whether argon laser coagulation was performed or not. A standardized follow-up was performed. The chorioretinal fluorescence pattern was reconstructed following TAG. Quantitative measurements were also performed. Results:, TAG performed from indocyanine green angiography (ICGA) showed smaller lesion size (LS) compared to fluorescein angiography (FA) (mean difference: early phase = ,1.6 mm2, late phase = ,1.8 mm2). The extent of mean LS from early to late phase increased by 0.8 mm2 in FA and by 0.6 mm2 in ICGA. TAG could visualize different degrees of leakage topographically. Conclusion:, TAG gives new insights into the pathophysiology of BRVO: it enables the visualization of dynamics of leakage and the demonstration of the effects of intravasal stasis. Furthermore, TAG is less impaired by masking phenomena than FA. Functional retinal imaging shows distinct advantages over OCT: quantification of leakage activity is possible using TAG. [source] Appraisal and management of subclinical choroidal inflammation: the iceberg phenomenonACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose To explore further the ocular fundal structures after funduscopy has been performed in intraocular inflammatory diseases, we have at our disposal among other investigational imaging methods, fluorescence angiography comprising fluorescein angiography (FA) and indocyanine green angiography (ICGA). In most cases dual FA & ICGA is necessary as the two methods image completely different structures. Fluorescein angiography is giving information on superficial structures including the optic disc, the retinal vessels and the retina as well as on the RPE, whereas ICGA is exploring the choroidal compartment. In contrast to FA that usually does not furnish additional information but is only giving more precise images of the superficial structures explored, ICGA is revealing elements, in case of choroidal inflammatory involvement, that no other method can show. The choroidal inflammatory lesions can be very extensive while often causing only faint or no signs during clinical examination and with other investigational imaging methods, a phenomenon which corresponds to the so-called "iceberg effect". This aptitude of ICGA to show lesions that are otherwise inaccessible make it an essential method to detect and follow choroidal lesions. Methods Cases where diagnosis cannot be made without ICGA or cases where inflammation can only be followeb by ICGA, the so-called iceberg constellation because other methods show only faint or no signs, will be presented. Conclusion Inflammatory lesions limited to the choroid cannot be detected without performing ICGA which is indispensible to diagnose purely choroidal diseae and to monitor the evolution of choroidal inflammation. [source] Gain in accuracy for diagnosis and follow-up of uveitis through indocyanine green angiographyACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose The proportion of diseases involving principally the choroid is as frequent if not more frequent than those involving the superficial structures of the fundus and are therefore not accessible or poorly accessible to fluorescein angiography (FA) nor OCT. Methods Illustrative cases where the preponderant lesions are in the choroid are presented showing that the detection and follow-up of choroiditis is only meaningful using indocyanine green angiography (ICGA). Results Diseases that do not involve the choroid are the minority. Except for intermediate uveitis, mainly of the pars planitis type, and Behçet's uveitis, choroidal involvement cannot be excluded. Therefore in most other uveitis cases with suspected posterior involvement, if angiographic investigation is felt necessary, the initial angiography should always be a dual FA/ICGA angiography even if the predominant fundus sign is retinal vasculitis. Only if the initial angiography does not show choroidal involvement can the follow-up be preformed by FA alone. Conclusion In order to perform adequate diagnosis, adequate assessement of lesions and adequate follow-up in uveitis cases with choroidal involvement ICGA is mandatory. [source] Global angiographic scoring system for inflammatory diseasesACTA OPHTHALMOLOGICA, Issue 2009M KHAIRALLAH Purpose Fundus fluorescein and indocyanine green angiography are essential imaging techniques in the appraisal of posterior segment inflammation. A combined fluorescein and indocyanine green angiographic scoring system has been developed in order to provide semi-quantitative data for follow-up of disease progression, monitoring response to treatment, and comparison between clinical studies. We tested interobserver variations in the semi-quantitative scoring of dual fluorescein/indocyanine green angiograms. Methods Four observers scored 32 dual fluorescein and indocyanine green angiograms. Spearman rank correlation was used to analyze correlation between scores assigned to each angiographic sign. We used the Kappa statistics to test agreement between pairs of observers in comparative total fluorescein and indocyanine green angiographic scores. Results We found a significant correlation between pairs of observers in scores assigned to each fluorescein angiographic sign and the total score of fluorescein angiograms. A significant correlation was found only between 2 separate pairs of observers in scores assigned to early stromal vessel hyperfluoresence on indocyanine green angiography. However, a significant correlation was found in other indocyanine green angiographic signs and the total score of indocyanine green angiograms. There was a good agreement between observers in comparative fluorescein , indocyanine green angiographic total scores. Conclusion Further experience with the scoring system, especially with the indocyanine green angiographic scoring, may improve its reproducibility. [source] Diagnosis of ophthalmic tumoursACTA OPHTHALMOLOGICA, Issue 2009T KIVELÄ Purpose To summarise clinical methods used to diagnose ophthalmic tumours. Methods Personal experience of the author as a member of the European Ophthalmic Oncology Group. Results Conjunctival tumours are excised based on provisional clinical diagnosis or, if they are extensive, atypical or part of systemic disease such as lymphoma, first biopsied to obtain a histopathologic diagnosis. Useful methods to diagnose and stage conjunctival tumours are high frequency ultrasonography (US) or ultrasound biomicroscopy (UBM) to measure their thickness, in vivo confocal microscopy or impression cytology to chart their extent, and exfoliative cytology to get a provisional diagnosis. Ciliary body tumours are visualised by radical biomicroscopy, transillumination and indirect ophthalmoscopy with scleral indentation, supplemented with high frequency US or UBM. Binocular indirect ophthalmoscopy and US form the basis or diagnosing choroidal tumours. In addition to fluorescein and indocyanine green angiography in atypical cases, optical coherence tomography to detect subretinal fluid and autofluorescence to detect orange pigment are useful adjuncts in telling a small melanoma from a naevus. The mnemonic "To Find Small Ocular Melanomas" (from Thickness >2mm, subretinal Fluid, Symptoms, Orange pigment, Margin touching disc) is also useful in this respect. Clinical diagnosis of medium-sized to large melanomas is 99% accurate, whereas a fine needle or vitrectomy biopsy may be necessary to diagnose atypical tumours and is also used for cytogenetic analysis of uveal melanomas. Conclusion Conjunctival tumours are mostly diagnosed histopathologically, whereas diagnosis of uveal tumours is usually based on clinical examination. While clinical diagnosis is usually reliable, biopsy of uveal tumours is increasingly used for prognostic purposes. [source] Ocular perfusion and age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 2 2001Thomas A. Ciulla ABSTRACT. Purpose: To review the role of ocular perfusion in the pathophysiology of age-related macular degeneration (AMD), the leading cause of irreversible blindness in the industrialized world. Methods: Medline search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Results: Vascular defects have been identified in both nonexudative and exudative AMD patients using fluorescein angiographic methods, laser Doppler flowmetry, indocyanine green angiography, and color Doppler imaging. Conclusion: Although these studies lend some support to the vascular pathogenesis of AMD, it is not possible to determine if the choroidal perfusion abnormalities play a causative role in nonexudative AMD, if they are simply an association with another primary alteration, such as a primary RPE defect or a genetic defect at the photoreceptor level, or if they are more strongly associated with one particular form of this heterogeneous disease. Further study is warranted. [source] Diode laser photocoagulation of choroidal neovascularization associated with retinal pigment epithelial detachmentACTA OPHTHALMOLOGICA, Issue 1 2001Francisco Gomez-Ulla ABSTRACT. Aims/Background: Association of choroidal neovascularization with pigment epithelial detachment is not an uncommon feature. Since this condition usually has a poor visual outcome, new treatments should be developed. Methods: We studied the anatomical and visual results of 11 eyes with this association as a manifestation of an Exudative Age Related Macular Degeneration which were treated with diode laser photocoagulation guided by indocyanine green angiography. The average follow up time was 25.5 months (from 12 to 48 months). Results: Complete closure with complete resolution of the exudates and flattening of the detachment was observed in five eyes (45%). Visual acuity in the final examination improved or remained stable in 6 cases (55%). Conclusion: These results indicate that diode laser photocoagulation guided by indocyanine green angiography is at least as effective as conventional lasers with shorter wavelengths for treatment of vascularized pigment epithelial detachments in Age Related Macular Degeneration. [source] Choroidal Langerhans' cell histiocytosisACTA OPHTHALMOLOGICA, Issue 1 2000In Taek Kim ABSTRACT. Purpose: To report a patient with choroidal Langerhans' cell histiocytosis. Methods: A solitary tumor was found in the left eye of a 49-year-old male who had no definite history of systemic disorders, but had observed visual disturbances for a period of 1 month. Ultrasonography, fluorescein angiography, and indocyanine green angiography were performed and the eyeball was enucleated. We prepared the specimen for microscopic examinations. Results: Fluorescein angiographic findings of the lesion were mottled hyperfluorescence in the arteriovenous phase and strong hyperfluorescence in the late phase. Hypofluorescence in both early and late phases showed on indocyanine green angiogram. The lesion of choroid was widely infiltrated by histiocytes, though no extraocular invasion was found. Immunohistochemical studies including S-100 and CD 68 staining revealed characteristic features of Langerhans' cell histiocytosis. Electron microscopic examination of the histiocytes showed histiocytosis X body (Birbeck granule) in the cytoplasm and indented nucleus. Conclusion: We consider that this is a case of choroidal Langerhans' cell histiocytosis with no evidence of systemic lesions. [source] Clinical use and research applications of Heidelberg retinal angiography and spectral-domain optical coherence tomography , a reviewCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2009Andrea Hassenstein MD Abstract Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the ,Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases. [source] | ||||||||||