Use of indocyanine green and sodium fluorescein for anterior segment angiography in ophthalmologically normal cats

Region-related and layer-specific permeability of the iris vasculature with morphological mechanism: A novel understanding of blood-aqueous barrier

The permeability of iris blood vessels has an important role in maintaining aqueous humor (AH) homeostasis, contributing to variation in iris volume and probably the pathogenesis of angle closure glaucoma. This study investigates the permeability of the iris microvasculature to plasma-derived protein and correspond it with the morphologic characteristics of vascular mural cells (MCs). Twenty-two enucleated porcine eyes were used in this study. 12 eyes were micro-perfused with vehicle alone as control or with FITC-albumin as a marker of protein leakage and histological sections subsequently made to examine for FITC-albumin presence. The other 10 eyes were immunolabeled via micro-perfusion for αSMA and VE-cadherin to investigate their topographic distribution in the porcine iris vasculature, and to cross correspond with the locations of FITC-albumin deposits. Distribution of FITC-signals exhibited a site-dependent pattern and time-dependent change in the iris. Fluorescence was initially detected around capillaries in the superficial and deep layer of the iris microvascular network. The pupillary region and the iris root retained more fluorescent signal than the iridal ciliary region. At low magnification, αSMA labelling displayed a regional variation which was inversely correlated with vascular permeability. At the cellular level, αSMA labeling corresponded with vascular MCs distribution in the iris vascular network. The correspondence between iris microvascular permeability to FITC-albumin and the pattern of αSMA distribution and MCs coverage adds to the understanding of the elements comprising the blood-aqueous barrier with implications for the bio-mechanics of iris volume change.

Indocyanine-based near-infrared lymphography for real-time detection of lymphatics in a cat with multiple mast cell tumours

Case summary

An 11-year-old female domestic shorthair cat was presented with cutaneous mast cell tumours (MCTs) localised at the right temporal region, the left buccal region and on the third digit of the right thoracic limb. Staging was negative and locoregional lymph nodes appeared normal, based on clinical findings. During surgery, real-time indocyanine green (ICG)-based lymphography was performed to detect the cutaneous draining pattern of all the primary MCTs. ICG was injected intracutaneously in four quadrants around each tumour, and a clear lymphogram was visible shortly after injection. Using near-infrared lymphography (NIR-L) for guidance, all lymphadenectomies were performed in 12 mins or less, with a maximal incision length of 3.5 cm. The smallest resected node was 0.9 cm in diameter. All MCTs were classified as low-grade cutaneous MCT. All four ICG-positive lymph nodes were considered premetastatic or metastatic. The only ICG-negative resected node was also negative for tumour cells. No complications related to NIR-L were recorded.

Relevance and novel information

This is the first description of NIR-L in a cat with MCT. Application was straightforward and ICG enrichment only occurred in the metastatic nodes, suggesting correct identification of lymphatic draining patterns. Of note, as previously described in dogs, we did detect nodal metastasis, despite low-grade primary tumours. The clinical relevance should be evaluated in future studies.

Assessment of iris vasculature abnormalities in dogs with diabetes mellitus

OBJECTIVE

To identify and characterize abnormalities of iris vasculature in dogs with diabetes mellitus, compared to clinically normal, age-matched control dogs, by means of anterior segment angiography.

ANIMALS

10 dogs with naturally occurring diabetes mellitus and 10 age-matched control dogs with no ocular or systemic disease.

PROCEDURES

The day before iris vasculature abnormality (IVA) assessment, all dogs underwent complete physical and ophthalmic examinations and baseline clinicopathologic analyses. For diabetic dogs, serum fructosamine concentration and a 12-hour blood glucose concentration curve were generated. The next day, all dogs were sedated and anterior segment angiography (following IV injection of indocyanine green [1 mg/kg] and subsequently sodium fluorescein [20 mg/kg]) was performed with a full-spectrum camera and camera adapter system. Group findings were compared, and multiple linear regression analysis was performed to identify potential factor associations with IVAs.

RESULTS

During anterior segment angiography, the arterial, capillary, and venous phases were identified in all dogs. Times to onset of all phases in diabetic dogs were significantly less than those in control dogs. Vascular disruptions within the peripupillary region (evident following sodium fluorescein administration) were common in diabetic dogs. Severity of dye leakage into the iris stroma and aqueous humor was significantly greater in diabetic dogs than in control dogs. Duration of disease, mean blood glucose concentration, and serum fructosamine concentration were significantly associated with IVAs.

CONCLUSIONS AND CLINICAL RELEVANCE

In diabetic dogs, anterior segment angiography revealed IVAs that were not evident in control dogs. The severity of those changes appeared to be associated with disease duration and blood glucose regulation.

The use of near infrared fluorescence imaging with indocyanine green for vascular visualization in caudal auricular flaps in two cats

OBJECTIVES

To describe the use of near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) for vascular visualization in two caudal auricular axial pattern flaps (APF).

ANIMALS

Two client-owned cats with upper eyelid masses.

STUDY DESIGN

Clinical case report.

METHODS

Wide surgical excision with enucleation was performed by using a caudal auricular APF for closure. Flap margins and perforating artery location were approximated with anatomical landmarks. The caudal auricular artery origin was then visualized percutaneously by using an exoscope with NIRF camera and light source after a single 2.5-mg dose of IV ICG. Margins were adjusted as required. The flaps were routinely elevated with continued intraoperative visualization of the artery and rotated to complete closure.

RESULTS

After IV ICG administration, fluorescence was initially visualized after 15 to 18 seconds and remained visible for up to 26 minutes. The achieved visualization led to flap margin adjustments in cat 1. Both cats recovered with minimal flap congestion, excellent hair regrowth, and no long-term complications (>186 days). Cat 1 experienced 100% flap survival. Cat 2 experienced 10% partial thickness flap necrosis, but revision was not required, and the flap was healed at recheck 85 days postoperatively.

CONCLUSION

The use of ICG for APF vessel visualization prior to and during flap elevation resulted in transcutaneous visualization of the perforating vessel and improved awareness of vessel location intraoperatively. These two cats experienced excellent flap survival without major complications. This report highlights the potential benefits of ICG NIRF in APF for animals undergoing reconstructive surgery.

Advanced Imaging of the Equine Eye

This article reviews the literature for studies describing advanced imaging of the equine eye as a reference for practitioners to help in the selection of image modalities, describe how to use the instruments, and help interpret the image findings. Indications for, technique of, and image interpretation of advanced image modalities such as ultrasound, computed tomography, MRI, optical coherence tomography, confocal microscopy, and angiography are reviewed. The article is organized anatomically, not by instrument, so that the reader will be able to quickly research ways to image specific disease entities or anatomic locations that are affecting their equine patients.

Comparison of indocyanine green and sodium fluorescein for anterior segment angiography of ophthalmically normal eyes of goats, sheep, and alpacas performed with a digital single-lens reflex camera adaptor

OBJECTIVE To compare results of anterior segment angiography of ophthalmically normal eyes of goats, sheep, and alpacas performed by use of indocyanine green (ICG) and sodium fluorescein (SF). ANIMALS 10 female goats (mean ± SD age, 6.8 ± 1.7 years), 10 female sheep (3.0 ± 2.2 years), and 10 alpacas (7 females and 3 males; 6.8 ± 3.8 years). PROCEDURES A catheter was aseptically placed into a jugular vein. Each animal was anesthetized and properly positioned, and 0.25% ICG was administered. Images were obtained by use of an adaptor system consisting of a modified digital single-lens reflex camera, camera adaptor, and camera lens. Images were obtained at a rate of 3 images/s for the 60 seconds immediately after ICG administration and then at 2, 3, 4, and 5 minutes after administration. Ten minutes later, 10% SF was administered IV and images were obtained in a similar manner. RESULTS Angiography with ICG provided visual examination of the arterial, capillary, and venous phases in all species. Visual examination of the iris vasculature by use of SF was performed in goats and sheep but was not possible in the alpacas because of iridal pigmentation. Extravasation of SF was a common finding in sheep and alpacas but not in goats. No adverse events were detected. CONCLUSIONS AND CLINICAL RELEVANCE Quality angiographic images of the anterior segment were obtainable after IV administration of ICG to goats, sheep, and alpacas. This may provide a useful imaging modality for ocular research in these animal species.