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Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema
  1. Daniela Castro Farías1,
  2. Rodrigo Matsui Serrano1,
  3. Juan Bianchi Gancharov1,
  4. Ulises de Dios Cuadras1,
  5. José Sahel2,
  6. Federico Graue Wiechers1,
  7. Benedicte Dupas3,
  8. Michel Paques2
  1. 1 Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico
  2. 2 Clinical Investigation Center 1423, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Sorbonne University, Paris, France
  3. 3 Lariboisière Hospital, University Paris 7, Paris, France
  1. Correspondence to Dr Michel Paques, Clinical Investigation Center, Quinze-Vingts hospital, Paris 7512, France; michel.paques{at}gmail.com

Abstract

Aims During diabetic macular oedema (DME), a spectrum of capillary abnormalities is commonly observed, ranging from microaneurysms to large microvascular abnormalities. Clinical evidence suggests that targeted photocoagulation of large microvascular abnormalities may be beneficial, but their detection is not done in a routine fashion. It was reported that they are better identified by indocyanine green angiography (ICGA) than by fluorescein angiography. Here, we investigated the prevalence and ICGA and optical coherence tomography (OCT) features of retinal microvascular abnormalities in a group of patients with DME.

Methods Observational study. The fundus photographs, ICGA and structural and angiographic OCT charts of 35 eyes from 25 consecutive patients with DME were reviewed.

Results 22 eyes (63%) had at least one focal area of microvascular abnormalities showing prolonged indocyanine green (ICG) staining (ie, beyond 10 mins after injection). In particular, all eyes (n=9) with circinate hard exudates showed foci of late ICG staining. These areas were either isolated globular capillary ecstasies or a cluster of ill-defined capillary abnormalities. They were located at a median distance of 2708 µm from the fovea (range: 1064–4583 µm). Their diameter ranged from 153 to 307 µm. During ICGA, 91% showed increased their contrast and apparent size in late frames, whereas 79% of microaneurysms showed reduced contrast on late frames. OCT angiography was not contributive for the detection of these lesions.

Conclusion Late ICG staining revealing large microvascular abnormalities is commonly observed during DME. Because of their specific angiographic and OCT features relative to microaneurysms, we propose to name them telangiectatic capillaries (TelCaps).

  • diabetic macular oedema
  • indocyanine green angiography
  • microvascular abnormalities
  • hard exudates
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Footnotes

  • Contributors All the listed authors have been involved in the undertaking of the clinical trial with emphasis on various aspects, from the conception of the lens design, fabrication of the lens and registration of the clinical trial and preparation of clinical protocol to data collection and analysis, interpretation and conclusions. A few manuscripts are now in preparation by the author’s team.

  • Funding Supported by the Agence Nationale de la Recherche (ANR-14-CE17-0011-01), the Association Contre l’OVR (www.asso-ovr.fr), the Programme Hospitalier de Recherche Clinique (TalaDMEproject PHRC-N-17-0334), the French Clinical Research Network and the Comité National Coordination Action Handicap.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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