ORIGINAL ARTICLES
Comparison of fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization in hemorrhagic age-related macular degeneration

https://doi.org/10.1016/S0002-9394(99)00388-8Get rights and content

Abstract

PURPOSE:

To compare fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization located under subretinal hemorrhage, in age-related macular degeneration.

METHODS:

In a retrospective study, 30 eyes of 30 consecutive patients with hemorrhagic age-related macular degeneration were evaluated with fluorescein angiography and indocyanine green angiography. In each eye, areas of macular hemorrhage, choroidal neovascularization, and total lesion (hemorrhage plus choroidal neovascularization) were measured, and the choroidal neovascularization was categorized as classic, occult, or mixed on fluorescein angiography, and as hot spot, plaque, or combined lesion on indocyanine green angiography. Results of the two techniques were compared for the ability to identify a laser-treatable lesion.

RESULTS:

Fluorescein angiography showed fluorescence in most cases (28, 93.3%). In 23 cases (76.6%), the fluorescence pattern was compatible with occult choroidal neovascularization. Indocyanine green angiography revealed defined patterns of fluorescence in 27 cases (90%): 12 hot spots, seven plaques, and eight combined hot spots and plaques. Twenty lesions (66.6%) detected by indocyanine green angiography were considered eligible for laser therapy. Nine of them (45%) were extrafoveal.

CONCLUSIONS:

Indocyanine green angiography is beneficial for imaging choroidal neovascularization located under subretinal hemorrhage. Choroidal neovascularization demonstrated on indocyanine green angiography may be considered eligible for laser treatment. Therefore, indocyanine green angiography should be considered in cases of hemorrhagic age-related macular degeneration.

Section snippets

Patients and methods

In a retrospective study, 30 eyes of 30 consecutive patients with clinically diagnosed hemorrhagic age-related macular degeneration were evaluated by both fluorescein angiography and indocyanine green angiography. In all cases the subretinal hemorrhage encompassed at least 50% of the total choroidal lesion on fluorescein angiography, that is, the size of the hemorrhage was greater than the size of any visible classic or occult choroidal neovascularization plus any other component of the lesion

Results

On fluorescein angiography, of the 30 cases of subretinal hemorrhage evaluated, 28 (93.3%) showed fluorescence. In 23 (76.6%), the fluorescence patterns were compatible with occult choroidal neovascularization. In three (10%), classic choroidal neovascularization was imaged, and in two (6.6%), combined classic and occult choroidal neovascularizations were imaged. Two (6.6%) had no visible fluorescence.

On indocyanine green angiography, 27 lesions (90%) showed defined patterns of fluorescence, as

Discussion

The visual loss in hemorrhagic age-related macular degeneration is caused more by the diskiform scarring and the recurrent hemorrhage than by direct toxic damage to the photoreceptors from acute bleeding. It is greater than that for subretinal hemorrhage resulting from other causes,11, 12 probably because of the location of the hemorrhage under the retinal pigment epithelium, as suggested by Gass.13 To minimize the irreversible damage, the underlying choroidal neovascularization needs to be

Acknowledgements

We are grateful for the editorial and secretarial help of Mrs Gloria Ginzach and Mrs Melanie Kawe.

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