Faculty Bibliography

PURPOSE: Digital indocyanine green videoangiography (ICG-V) was used to study recurrent choroidal neovascularization (CNV) in patients with the clinical and fluorescein angiographic findings indicative of ill-defined, or recurrent occult, CNV (RO-CNV). The use of ICG-V-guided laser caphotocoagulation as an alternative form of treatment was also investigated when a well-delineated area of CNV was imaged with this technique. METHODS: A consecutive series of 66 patients were studied who presented with exudative age-related macular degeneration and symptoms and clinical manifestations of recurrent CNV in which fluorescein angiography did not reveal classic, or well-defined, neovascularization. Patients were selected for laser treatment based on conventional guidelines if ICG-V imaged a well-delineated area of recurrent CNV. RESULTS: Indocyanine green videoangiography showed late staining that was consistent with recurrent CNV in 64 (97%) of these 66 patients with RO-CNV. Twenty-nine (44%) of the 66 were eligible for laser treatment, and 18 (62%) of these 29 patients experienced successful anatomic and visual results, which were defined as resolution of the exudative manifestations and improvement or stabilization (+/- 1 line on a Snellen chart) of vision. CONCLUSIONS: This pilot study suggests that ICG-V is of value in imaging patients with RO-CNV after laser photocoagulation for CNV secondary to age-related macular degeneration. Laser treatment of RO-CNV with ICG-V guidance may be successful both anatomically and functionally in a promising number of these otherwise untreatable cases. Further studies are necessary to validate these preliminary findings

PURPOSE: To evaluate the use of digital indocyanine green videoangiography in patients with clinical and fluorescein angiographic evidence of 'occult' choroidal neovascularization in age-related macular degeneration and to investigate indocyanine green videoangiography-guided laser photocoagulation as a therapeutic approach. METHODS: Three hundred forty-seven consecutive patients with exudative age-related macular degeneration and symptoms and clinical manifestations of occult choroidal neovascularization were studied with indocyanine green videoangiography. Patients were selected for laser treatment, using conventional guidelines, when indocyanine green videoangiography demonstrated a well-delineated area of hyperfluorescence, presumed to be a focal area of choroidal neovascularization. RESULTS: Seventy-nine (23%) of 347 eyes were found to have a localized and definable lesion that was potentially amenable to laser photocoagulation therapy; 44 (56%) of these 79 treated eyes had complete resolution of their exudative manifestations. Visual acuity improvement was noted in 10 (13%) of 79 eyes, and stabilization of vision achieved in 42 eyes (53%). CONCLUSION: Laser photocoagulation treatment guided by indocyanine green videoangiography was shown to produce promising anatomical and visual improvement in a small number of patients with occult choroidal neovascularization secondary to age-related macular degeneration. This pilot study warrants further research to investigate the efficacy and safety of this form of treatment

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)

Juvenile xanthogranuloma is a benign cutaneous disorder which occasionally involves the eye, orbit, and ocular adnexa in children. Iris and ciliary body manifestations are commonly seen, but retinal and choroidal lesions are exceedingly rare. We report a unique case of retinal, choroidal, iris, and ciliary body infiltration in a 12-year-old patient diagnosed by excisional biopsy of the iris. The diagnosis was confirmed by routine histology and oil-red-o staining. Immunohistochemistry revealed predominantly macrophages, monocytes, and T-helper lymphocytes. Unusual features of this case include the late age at diagnosis, posterior pole involvement, and lack of cutaneous lesions. The presence of cellular adhesion molecules and T lymphocytes implicate a lymphocyte-driven inflammatory process. Apolipoprotein A was the predominant apolipoprotein present within the foamy histiocytes. We also present a critical review of the literature

OBJECTIVE: The clinicopathologic features of age-related macular degeneration (AMD) with occult choroidal neovascularization (CNV) detected by digital indocyanine green (ICG) videoangiography in an 82-year-old woman are discussed. METHODS: Serial sections through the macula of both eyes were prepared, and two-dimensional reconstruction maps depicting the histopathologic features were drawn. A technique by which electron microscopic examination of sections removed from glass slides was performed is described. RESULTS: Histopathologic examination of the lesion disclosed a 3.5 mm x 0.02 mm thick fibrovascular subretinal pigment epithelial choroidal neovascular membrane in an eye with diffuse basal laminar deposit in the macula. CONCLUSION: This case represents the first clinicopathologic correlation involving ICG videoangiography of CNV. The findings support the growing clinical impression that ICG videoangiography is of value in identifying what has been previously described as ill-defined or occult CNV