Ichiro Fukushima

Indocyanine green angiography and pathophysiology of multifocal posterior pigment epitheliopathy.

PURPOSE To clarify the pathophysiology of multifocal posterior pigment epitheliopathy (MPPE), or bullous retinal detachment (RD)-an unusual manifestation of central serous chorioretinopathy (CSC)-we evaluated indocyanine green (ICG) angiographic findings of patients with MPPE. METHODS Indocyanine green angiography was performed on 45 eyes of 26 patients with MPPE in our clinic during a 4-year period and compared with clinical and fluorescein angiographic (FA) findings. RESULTS Ophthalmoscopically, in the posterior pole there were multiple yellowish-white retinal exudations, associated with flat, serous RD and bullous RD in the lower periphery. Fluorescein angiography demonstrated multiple massive leakages from the choroid into the subretinal space. These leakage sites corresponded to the retinal exudations. Indocyanine green angiography showed hyperfluorescence in the posterior pole of the choroid. The hyperfluorescence was first seen in the middle phase and became prominent in the late phase. This finding seems to be due to extravasation from the choriocapillaris. After laser photocoagulation of the leakage sites seen on FA, the leakages stopped and the retinal exudations and RD were resolved. Indocyanine green angiography, however, revealed hyperfluorescence in the posterior pole that was seen in active stage. DISCUSSION AND CONCLUSION These ICG angiographic findings for MPPE show that hyperpermeability of the choroidal vessels may be the primary causative lesion. This is followed by an intrastromal accumulation of the extravasated choroidal fluid, which may be subclinical. Involvement of the retinal pigment epithelium may be secondary, and then the disease becomes manifest with RD. In MPPE, a severe form of CSC, the retinal pigment epithelium is involved extensively and widely, and prognosis is unfavorable. We conclude that MPPE and CSC represent opposite ends of a common morbid spectrum.

Optical coherence tomographic findings of idiopathic polypoidal choroidal vasculopathy.

BACKGROUND AND OBJECTIVE To identify the histological level of abnormal vessels associated with idiopathic polypoidal choroidal vasculopathy (IPCV), we examined IPCV with Optical Coherence Tomography (OCT). PATIENTS AND METHODS Fourteen patients diagnosed with IPCV were examined with Indocyanine green (ICG) angiography and OCT. RESULTS ICG angiography demonstrated branching vascular networks with polypoidal dilatations at the terminals beneath the retinal pigment epithelium (RPE). OCT showed dome-like elevation of the RPE, and moderate reflex or nodular appearance were seen beneath the RPE. CONCLUSION The abnormal vessel associated with IPCV is supposed to be choroidal neovascularization with polypoidal dilatations at the terminals between Bruchs membrane and RPE. We consider that this disease is a peculiar form of age-related macular degeneration.

Comparison of indocyanine green and fluorescein angiography of choroidal neovascularization

We compared indocyanine green (ICG) and fluorescein angiography for evaluation of choroidal neovascularization (CNV). Cast preparations of CNV induced in monkey eyes by laser photocoagulation were correlated with ICG and fluorescein angiographies of the same CNV formations. Fluorescein angiography was more effective, in general, than ICG angiography in detecting CNV; however, CNVs with subretinal hemorrhage (2 of 35 sites) were visible only with ICG angiography. In early phase ICG angiography, CNV formations that casts showed to be dense or composed of thick vessels were seen, but less dense areas were not visible. Lesions that ICG angiography revealed as leaking were not differentiated morphologically from non-leaking areas by the CNV casts. This study confirms that only ICG angiography can identify CNV hidden by subretinal hemorrhage, although fluorescein angiography is otherwise superior. Indocyanine green angiography is indicated as a valuable complement to fluorescein angiography for evaluation of CNV.

Histological Proof of Indocyanine Green Angiography: Healthy Eyes

PURPOSE To determine the histological localization of indocyanine green (ICG) in the healthy rat eye and to correlate this with ICG angiographic findings. METHODS After intravenous ICG dye injection, the rat eyes were enucleated and processed by freeze-substitution fixation with acetone. The tissue sections were stimulated with an 805-nm diode laser and observed with an infrared microscope with an intensified charge coupled device camera. The histological examinations of ICG localization were correlated with the ICG angiographic images. RESULTS ICG dye did not leak from the retinal and iris vessels. However, in the choroid, extravasation of ICG from the choriocapillaris was observed. The extravascular ICG from the choriocapillaris slowly diffused to the choroidal stroma but did not diffuse to the neurosensory retina through the retinal pigment epithelium. CONCLUSIONS Change in the localization of ICG in ocular tissue was demonstrated in the ICG angiographic findings. These results help to interpret clinical ICG angiographic findings.

Indocyanine green angiography in multifocal posterior pigment epitheliopathy

This paper describes the clinical features and pathophysiology of a peculiar type of non-rhegmatogenous, exudative retinal detachment, which was called bullous retinal detachment by Gass1, and which is an unusual manifestation of central serous chorioretinopathy (CSC). We propose the term, multifocal posterior pigment epitheliopathy (MPPE), for this clinical entity2. This disease has previously been called as multiple serous chorioretinopathy3 and idiopathic exudative retinal detachment4, among others5.