Intraoperative indocyanine green videoangiography in subretinal surgery

Indocyanine green angiography in posterior uveitis

Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.

Fluorescein angiography of peripheral retina and pars plana during vitrectomy for proliferative diabetic retinopathy

PURPOSE

To evaluate the extreme peripheral retina and pars plana during vitrectomy in patients with proliferative diabetic retinopathy.

METHODS

In a prospective study using a modified ophthalmic endoscopic system and an intraocular light source, we performed fluorescein angiography during pars plana vitrectomy in 12 eyes of 10 patients with proliferative diabetic retinopathy. Vitrectomy had been performed previously in two patients, and the subsequent surgery was necessary because of recurrent vitreous hemorrhage in one patient and silicone oil removal in the other.

RESULTS

All 12 eyes of 10 patients demonstrated a wide avascular area in the peripheral retina anterior to the previous photocoagulation scar. At the ora serrata in two eyes, a fibrovascular ridge of peripheral retinal vessels with fluorescein leakage that resembled the demarcation line in retinopathy of prematurity was noted; one eye had developed neovascular glaucoma 4 weeks after vitrectomy with maximum augmentation of endolaser photocoagulation, and the other eye had neovascular glaucoma that had been treated with photocoagulation 1 year before vitrectomy. In the two eyes that had undergone previous pars plana vitrectomy, fluorescein leakage was apparent at the fibrous scar of the sclerotomy site.

CONCLUSION

Intraoperative fluorescein angiography using an endoscope disclosed unusual findings in the extreme peripheral retina and pars plana of patients with proliferative diabetic retinopathy. Intraoperative fluorescein angiography may aid intraoperative evaluation and treatment of proliferative diabetic retinopathy.