Indocyanine green angiography in age-related macular degeneration with occult neovascularization

Retinal pigment epithelial detachment

Detachment of the retinal pigment epithelium is a prominent feature of many chorio-retinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase "detachment of the retinal pigment epithelium" is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations.

Pigment epithelium defects after submacular surgery for choroidal neovascularization: first results

It was the aim of this study to compare postoperative pigment epithelium defects after submacular surgery for well-defined choroidal neovascularization (CNV) with preoperative fluorescein angiogram (FAG), indocyanine green angiogram (ICG), and intraoperative findings of the excised neovacularization. Surgical removal of the CNV was videotaped. By means of a gauge the absolute size of an anatomic structure was determined which was visible on video, FAG, and ICG as well. Postoperatively another FAG was performed to further examine the funduscopically visible pigment epithelium defect. By comparison with the above-mentioned anatomic structure it was thus possible to determine the exact size of CNV and pigment epithelium defect. The extent of the pigment epithelium defect as determined on postoperative FAG after submacular surgery surpasses the size of CNV as measured in FAG, ICG, and anatomical preparation.

The present role of indocyanine green angiography in ophthalmology

Recent developments in the clinical application of indocyanine green angiography have mainly concerned refining its role as an adjunct to fluorescein angiography in detecting and guiding the treatment of choroidal neovascularization. We now have a better understanding of the different patterns of abnormal hyperfluorescence seen with indocyanine green angiography in eyes with both wet and dry forms of macular degeneration. In exudative cases, the success rate of laser treatment guided by indocyanine green angiographic findings can vary considerably, and it is now known which angiographic presentations are not as likely to benefit. In dry macular degeneration, indocyanine green angiography appears to add clinically useful information, such as helping to identify plaques in fellow eyes with choroidal neovasculrization or watershed zones that may be predictive of future exudative transformation. In certain circumstances, indocyanine green angiography can be valuable in detecting choroidal neovascularization in other macular diseases or in helping to diagnose other choroidal conditions, especially when the clinical presentation is atypical, such as central serous chorioretinopathy in elderly patients.