Faculty Bibliography

BACKGROUND: Although adverse reactions to indocyanine green (ICG) are known to occur, the dye has been used for more than 30 years in tests of cardiac and hepatic function, with a high level of safety. Improved digital video technology has renewed interest in the use of intravenous ICG in ophthalmic imaging. This report describes the authors' experience regarding the safety of ICG for digital angiography and their recommendations for its use in the ophthalmic setting. METHODS: Digital ICG videoangiography was performed in 1226 consecutive patients, and 1923 ICG videoangiography tests were performed. A registry of adverse reactions to ICG was established. Criteria were used to define mild, moderate, and severe adverse reactions, and these data were recorded for every ICG study performed. RESULTS: There were three (0.15%) mild adverse reactions, four (0.2%) moderate reactions, and one (0.05%) severe adverse reaction. There were no deaths. CONCLUSIONS: This study documents the safety of intravenous ICG for use in ophthalmic videoangiography

PURPOSE: Indocyanine green (ICG) dye is known to remain selectively in and around choroidal neovascularization (CNV) associated with age-related macular degeneration, and is thought to be cleared from the overlying retinal circulation without leakage. This is the basis of ICG dye-enhanced laser photocoagulation. The authors have observed, however, leakage of ICG dye into cystoid spaces within the retinal and have determined the incidence, clinical features, and angiographic characteristics of this newly described phenomenon. METHODS: The digital ICG videoangiograms of 149 consecutive patients with exudative age-related macular degeneration and occult CNV were reviewed independently to determine the characteristics of intraretinal ICG dye leakage. RESULTS: Of the 149 patients with occult CNV, 16 (11%) demonstrated intraretinal leakage of ICG dye between 14 and 34 minutes (median = 20 minutes). The clinical features most commonly associated with this phenomenon are: subretinal fluid (88%), subretinal hemorrhage (88%), subretinal lipid (63%), and retinal pigment epithelial detachment (56%). CONCLUSIONS: Indocyanine green dye may not be as concentrated in and around CNV as previously reported. The delayed onset of its appearance within intraretinal cystoid spaces may suggest a diffusible choroidal source of leakage. Intraretinal ICG dye may be a relative contraindication for ICG dye-enhanced laser photocoagulation

BACKGROUND: The role of vitreoretinal traction in the macular region as a causative factor for the development of idiopathic macular holes is widely accepted. The purpose of this study is to provide a prospective evaluation of patients with idiopathic macular holes to determine the risk of hole formation in the fellow eye. METHODS: The authors performed a prospective study of 50 patients with unilateral idiopathic macular holes combining complete ocular examination, including slit-lamp biomicroscopy, with kinetic B-scan ultrasound evaluation of the status of the vitreoretinal interface. Natural history data were obtained by follow-up examinations performed at 3-month intervals throughout the course of the study. RESULTS: During a median follow-up of 33 months, a full-thickness macular hole developed in 1 (2%) of 46 normal fellow eyes. Full-thickness holes also developed in three (75%) of the four eyes that had premacular hole changes (stages 1A and 1B) in the fellow eye on initial examination. All macular holes in fellow eyes occurred within 24 months of entry into the study. Kinetic ultrasound evaluation determined that fellow eyes with separation of the posterior hyaloid membrane in the foveal region were protected from future macular hole development. Those patients with attachment of the posterior hyaloid membrane in both eyes were at highest risk of holes forming in the fellow eye. Patients with posterior hyaloid membrane separation in the macular hole eye only, with an attached vitreous in the fellow eye, were at intermediate risk. CONCLUSION: The authors suggest that fellow eyes in patients with unilateral idiopathic macular holes have a relatively favorable natural history and that kinetic ultrasound examination may help determine which of these fellow eyes is at highest risk for full-thickness macular holes developing

BACKGROUND: Occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is known to occur with and without an associated serous pigment epithelial detachment (PED). Digital indocyanine green (ICG) videoangiography has been reported to provide enhanced definition of occult CNV. METHODS: A total of 244 of 657 (37%) consecutive patients with AMD, with occult CNV and an associated serous PED evident on fluorescein angiographic examination, were further studied with ICG videoangiography. RESULTS: On ICG videoangiographic examination, 9 of the 244 (4%) eyes had no evidence of underlying CNV, or essentially a pure serous PED. Each of the remaining 235 eyes (96%) had evidence of neovascularization and were defined as having a vascularized PED. These eyes were further divided into two groups, depending on the size and delineation of the neovascularization seen. Of the 235 eyes with vascularized PEDs, 89 (38%) had a solitary area of neovascularization that was well delineated, no more than one disc area in size, and defined as focal CNV. The other 146 (62%) eyes had a larger area of neovascularization, with variable delineation, defined as plaque CNV. Based on conventional guidelines, some patients were considered to be potentially eligible for laser photocoagulation treatment. CONCLUSION: The results of this study suggest that ICG videoangiography may be an important adjunct to the diagnosis, classification, and potential treatment of patients with AMD and occult CNV associated with a serous PED (vascularized PED)

The use of indocyanine-green videoangiography as an adjunctive technique to fluorescein angiography in the diagnosis of choroidal neovascularization has recently gained widespread attention. In January 1993, the first international symposium on indocyanine-green angiography was sponsored by the Manhattan Eye, Ear, and Throat Hospital. Approximately 300 retina specialists from all over the world convened at this meeting. Our current knowledge of indocyanine-green videoangiography is reviewed

Interferon alfa is used to treat various systemic disorders and recently has been suggested as a possible treatment for choroidal neovascularization. We report 10 cases of retinal ischemia associated with the use of interferon alfa for various illnesses. The retinal findings include cotton-wool spot formation, capillary nonperfusion, arteriolar occlusion, and hemorrhage. The retinal complications may sometimes be reversible when treatment is stopped. Our findings emphasize the need to have patients who are receiving interferon alfa therapy monitored for these retinal complications, which may rarely be associated with permanent loss of vision secondary to closure of retinal capillaries