Carlos Auer

Sensitivity of indocyanine green angiography for the follow-up of active inflammatory choriocapillaropathies

BACKGROUND: Inflammatory choriocapillaropathies (choriocapillaritis) correspond to the clinical spectrum of lesions of the fundus, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC), and other rarer entities caused by inflammatory disturbances of choriocapillaris perfusion. The aim here was to study the sensitivity of indocyanine green (ICG) angiography in investigating and following inflammatory choriocapillaropathies. PATIENTS AND METHODS: Patients with inflammatory choriocapillaropthies were included who had had a dual fluorescein and ICG angiography as well as visual field testing (Goldman or computerized perimetry) at presentation and on follow-up visits. ICG angiography was performed according to a routine angiographic protocol used for inflammatory diseases and was correlated with fundus examination, fluorescein angiography, and visual field testing. RESULTS: Three patients with MEWDS, two with APMPPE, and two with MC were included. The visual field alterations in all seven patients were well correlated with the extent of the hypofluorescent areas seen on ICG angiography, whereas they were badly correlated with fluorescein angiographic signs and their evolution. The visual field in MEWDS was particularly well correlated with the importance of peripapillary hypofluorescence seen on ICG angiography. In MC, the evolution of new lesions was well demonstrated by ICG angiography and well correlated with visual symptoms and visual fields, but was barely detected on fundus examination and by fluorescein angiography. CONCLUSIONS: ICG angiographic signs were shown to be closely correlated with visual function (visual field testing). This was not the case for either fundus examination or fluorescein angiography. ICG angiography appears as a very sensitive follow-up parameter in inflammatory choriocapillaropathies, giving morphological information on the evolution of the disease and on the response to treatment when therapy is indicated.

Indocyanine green angiographic findings in sympathetic ophthalmia.

Abstract · 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.

Indocyanine green angiographic features in posterior scleritis.

PURPOSE To determine choroidal involvement in posterior scleritis by examining indocyanine green angiographic features. METHODS Indocyanine green angiography was performed according to a standard uveitis angiographic protocol in eight consecutive patients with posterior scleritis. Indocyanine green angiography data were compared to fundus color photographs, red-free photographs, and fluorescein angiography. RESULTS The principal indocyanine green angiographic feature was diffuse zonal choroidal indocyanine green hyperfluorescence in the intermediate (+/-10 minutes) and late (+/-40 minutes) phases of angiography present in all eight patients who regressed in response to anti-inflammatory therapy. In four patients (two with massive subretinal exudation), additional fluorescing pinpoints were present in the zonal hyperfluorescent areas. Additional features included irregular delayed choroidal perfusion (five of eight patients)--irregularly distributed dark dots that were present up to the intermediate phase and becoming isofluorescent in the late phase that gave a mottled aspect to the choroid--and enlargement of draining choroidal veins. In bilateral patients, clinical features and indocyanine green angiography signs were roughly symmetric. CONCLUSIONS In posterior scleritis, indocyanine green angiography allowed us to identify areas of choroidal hyperfluorescence, possibly indicating areas of maximal inflammatory activity, and demonstrated regression of hyperfluorescence in response to therapy. Indocyanine green angiography was useful in assessing the extent of choroidal involvement and will probably serve as one of the follow-up parameters for disease evolution and response to therapy.

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.

Toxoplasmic retinochoroiditis: new insights provided by indocyanine green angiography.

PURPOSE To analyze features of indocyanine green angiography associated with recurrent toxoplasmic retinochoroiditis. METHODS Indocyanine green angiography was performed according to a standard protocol and correlated with clinical signs and fluorescein angiography in 12 eyes of 12 consecutive patients with recurrent toxoplasmic retinochoroiditis. RESULTS In 10 of 12 eyes with recurrent toxoplasmic retinochoroiditis, indocyanine green angiography showed multiple satellite dark dots not seen on fluorescein angiography or clinical examination of the fundus. CONCLUSION Indocyanine green angiography shows that recurrent toxoplasmic retinochoroiditis is more widespread than clinically visible lesions indicate. Indocyanine green angiography is useful in assessing the extent of involvement of recurrent toxoplasmic retinochoroiditis and the evolution of lesions and might also provide insights into the pathophysiology of the disease.

Recurrent toxoplasmic retinochoroiditis Significance of perilesional satellite dark dots seen by indocyanine green angiography

PURPOSE To suggest an explanation for the satellite dark dots seen by indocyanine green angiography (ICGA) around the main focus of a toxoplasmic retinochoroiditis. METHODS The authors analysed the evolution of ICG satellite dark dots in two cases of recurrent toxoplasmic retinochoroiditis receiving anti-toxoplasmic treatment not including corticosteroids. RESULTS Both patients had a recurrence on the peripheral aspect of scars from previous retinochoroiditis and were treated with pyrimethamine (50 mg/day) and sulfadiazine (4 g/day) for seven weeks. Resolution of satellite ICG dark dots was observed in both cases on the follow-up ICG angiogram performed at the end of treatment. CONCLUSION Resolution of ICG satellite dark dots after anti-toxoplasmic treatment not including corticosteroids tends to indicate that there is probably an infectious component in these hypofluorescent dots and that they probably do not represent a purely inflammatory perilesional reaction.

Toxoplasmic retinochoroiditis: resolution without treatment of the perilesional satellite dark dots seen by indocyanine green angiography

Abstract · Purpose: Satellite dark dots (SDD) seen by indocyanine green angiography (ICGA) around the main retinochoroiditis focus are described in 75% of cases. Whether SDDs represent subclinical infectious foci or just a perilesional inflammatory reaction is not known. The purpose here was to report a case giving additional information on this question. · Methods: We analysed the evolution of ICGA SDDs in a patient with recurrent toxoplasmic retinochoroiditis who received no anti-toxoplasmic treatment because the lesion was located outside the areas where treatment is classically recommended. · Results: The patient had a recurrence of retinochoroiditis on the nasal aspect of the disc about 2 disc diameters away from the disc. It was decided to observe the recurrence before introducing treatment. Diminution of SDDs occurred by 3 weeks after the initial ICGA, and complete resolution was observed on a follow-up ICG angiogram obtained 8 weeks after the initial visit. · Conclusion: Resolution of ICGA SDDs in toxoplasmic retinochoroiditis seems to occur in a similar fashion whether or not the retinochoroiditis is treated by anti-toxoplasmic drugs, indicating that SDDs probably represent a non-infectious perilesional inflammatory reaction.