Indocyanine Green Angiography of Drusen

doi:10.1016/S0002-9394(14)70826-8

American Journal of Ophthalmology

Volume 124, Issue 3, September 1997, Pages 344-356

https://doi.org/10.1016/S0002-9394(14)70826-8 Get rights and content

Purpose

To analyze the indocyanine green angiographic findings of drusen in the early stages of age-related macular degeneration.

Methods

Sixty-nine eyes of 53 consecutive patients with drusen but without exudative complications of age-related macular degeneration were studied. Drusen were classified into four groups: hard drusen, drusen derived from clusters of hard drusen (hard cluster-derived drusen and soft cluster-derived drusen), membranous drusen, and regressing drusen. An additional category was constituted by reticular pseudodrusen that could be associated with drusen of either the inner or outer macula. Results of contact lens biomicroscopy and fluorescein angiography were compared with findings on indocyanine green angiography.

Results

Hard drusen, either isolated hard drusen or hard cluster-derived drusen, were hyperfluorescent during indocyanine green angiography; in contrast, all sizes of soft drusen derived from clusters of hard drusen were hypofluorescent throughout the angiogram. Membranous drusen, visible on biomicroscopy and fluorescein angiography, were not visible during indocyanine green angiography. Regressing drusen may have showed hyperfluorescence at the early stages of indocyanine green angiography, but associated calcium and pigmentation were hypofluorescent. Reticular pseudodrusen were visible on red-free photographs; on midphase and late-phase indocyanine green angiography using the scanning laser ophthalmoscope only, reticular pseudodrusen were seen as a pattern of hypofluorescent dots.

Conclusion

The indocyanine green angiographic findings add to and support the clinicopathologic classification of drusen. Indocyanine green angiography may help to distinguish the different types of drusen and may thus be of use in evaluating the risk of progressive age-related macular degeneration in patients with drusen.

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Cited by (93)

Value and Significance of Hypofluorescent Lesions Seen on Late-Phase Indocyanine Green Angiography
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The hypofluorescence of fundus lesions observed during the late phase of indocyanine green angiography (ICGA) in various diseases has often been overlooked or misinterpreted. This article explores the significance of fundus lesions that are initially isofluorescent during the early phase of ICGA but become hypofluorescent later in the examination.
Pathologies such as multiple evanescent white spot syndrome, acute posterior placoid syphilitic chorioretinitis, chronic central serous chorioretinopathy, choroidal hemangioma, and some fundus with drusen, present this phenomenon of late hypofluorescence.
The interpretation of ICGA images and the role of indocyanine green (ICG) uptake by the retinal pigment epithelium (RPE) in late fundus fluorescence is debated. Experimental evidence suggests that ICG accumulates progressively in the RPE after intravenous injection of the dye or after direct contact in vitro, making it a potential marker of RPE activity. Although the exact mechanisms of ICG diffusion through the choroid and its binding to the RPE require further investigation, the late hypofluorescence observed in certain ICGA diseases provides information on different modalities of RPE dysfunction.
The author has no proprietary or commercial interest in any materials discussed in this article.
Influence of drusenoid pigment epithelial detachments on the progression of age-related macular degeneration and visual acuity
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To analyze the presence and morphologic characteristics of drusenoid pigment epithelial detachments (DPEDs) in spectral-domain optical coherence tomography (SD-OCT) in Caucasian patients with early and intermediate age-related macular degeneration (AMD) as well as the influence of these characteristics on best-corrected visual acuity (BCVA) and disease progression.
Prospective observational cohort study. Participants: 89 eyes of 56 patients with early and intermediate AMD.
Examinations consisted of BCVA, SD-OCT, and indocyanine green angiography. Evaluated parameters included drusen type, mean drusen height and -volume, the presence of DPED, DPED maximum height, -maximum diameter, -volume, topographic location, the rate of DPED collapse, and the development of macular neovascularization (MNV) or geographic atrophy (GA).
DPED maximum height (162.34 µm ± 75.70 μm, p = 0.019) was significantly associated with the development of GA and MNV. For each additional 100 μm in maximum height, the odds of developing any late AMD (GA or MNV) increased by 2.23 (95% CI = 1.14–4.35). The presence of DPED (44 eyes, p = 0.01), its volume (0.20 mm ± 0.20 mm, p = 0.01), maximum diameter (1860.87 μm ± 880.74 μm, p = 0.03), maximum height (p < 0.001) and topographical location in the central millimetre (p = 0.004) of the Early Treatment Diabetic Retinopathy Study (ETDRS)-Grid were significantly correlated with BCVA at the last follow-up (0.15logMAR ± 0.20logMAR; Snellen equivalent approximately 20/28). DPEDs occurred significantly less in the outer quadrants than in the central millimetre and inner quadrants of ETDRS-Grid (all p values < 0.001).
The height of drusen and DPEDs is a biomarker that is significantly associated with the development of late AMD and visual loss. DPEDs affect predominantly the center and inner quadrants of the ETDRS-Grid.
Multimodal imaging in pachychoroid spectrum
2022, Survey of Ophthalmology
Diagnostic investigation on pachychoroid spectrum disease (PSD) has been growing along with the rapid advancement of imaging technology. In optical coherence tomography (OCT)-based studies, choroidal thickness profile, luminal and stromal choroidal ratio, and abnormalities in the neurosensory retina have demonstrated various patterns in different clinical entities related to PSD. The emerging role of OCT angiography ()CTA) has been expanded to involve the quantitative analysis of the OCTA parameters in different clinical entities of PSD and to evaluate the choriocapillaris signal void and vessel density as indicators of choriocapillaris ischemia. OCTA has broadened our knowledge in characterization and assessment of both active and quiescent choroidal neovascularization and its association with treatment response. Recent studies using indocyanine green angiography have focused on the evaluation of choroidal vascular hyperpermeability and its relationship with other pachychoroid related features. Ultra-widefield indocyanine green angiography enables observation and characterization of peripheral choroidal pathologies and their associations with macular abnormalities. Multicolor imaging is an emerging modality with the capability to demonstrate early abnormalities in PSD. We summarize all investigations reflecting the new insights into the application of multimodal imaging for PSD and focus on novel findings observed in different clinical entities with each imaging modality.
Cuticular Drusen: Clinical Phenotypes and Natural History Defined Using Multimodal Imaging
2018, Ophthalmology
To define the range and life cycles of cuticular drusen phenotypes using multimodal imaging and to review the histologic characteristics of cuticular drusen.
Retrospective, observational cohort study and experimental laboratory study.
Two hundred forty eyes of 120 clinic patients with a cuticular drusen phenotype and 4 human donor eyes with cuticular drusen (n = 2), soft drusen (n = 1), and hard drusen (n = 1).
We performed a retrospective review of clinical and multimodal imaging data of patients with a cuticular drusen phenotype. Patients had undergone imaging with various combinations of color photography, fluorescein angiography, indocyanine green angiography, near-infrared reflectance, fundus autofluorescence, high-resolution OCT, and ultrawide-field imaging. Human donor eyes underwent processing for high-resolution light and electron microscopy.
Appearance of cuticular drusen in multimodal imaging and the topography of a cuticular drusen distribution; age-dependent variations in cuticular drusen phenotypes, including the occurrence of retinal pigment epithelium (RPE) abnormalities, choroidal neovascularization, acquired vitelliform lesions (AVLs), and geographic atrophy (GA); and ultrastructural and staining characteristics of druse subtypes.
The mean age of patients at the first visit was 57.9±13.4 years. Drusen and RPE changes were seen in the peripheral retina, anterior to the vortex veins, in 21.8% of eyes. Of eyes with more than 5 years of follow-up, cuticular drusen disappeared from view in 58.3% of eyes, drusen coalescence was seen in 70.8% of eyes, and new RPE pigmentary changes developed in 56.2% of eyes. Retinal pigment epithelium abnormalities, AVLs, neovascularization, and GA occurred at a frequency of 47.5%, 24.2%, 12.5%, and 25%, respectively, and were significantly more common in patients older than 60 years of age (all P < 0.015). Occurrence of GA and neovascularization were important determinants of final visual acuity in eyes with the cuticular drusen phenotype (both P < 0.015). Small cuticular drusen typically demonstrated a homogenous ultrastructural appearance similar to hard drusen, whereas fragmentation of the central and basal contents was seen frequently in larger cuticular drusen.
Although the ultrastructural characteristics of cuticular drusen appear more similar to those of hard drusen, their lifecycle and macular complications are more comparable with those of soft drusen. Cuticular drusen phenotype may confer a unique risk for the development of GA and neovascularization.
Choroidal Imaging in Dry Age-Related Macular Degeneration
2017, Choroidal Disorders
Age-related macular degeneration (AMD) is the most common form of irreversible vision loss in the Western world. AMD is classified into the dry, nonexudative, nonneovascular form and the wet, exudative, and neovascular type. The presence of centrally involving geographic atrophy (GA) in eyes with dry AMD or choroidal neovascularization in eyes with wet AMD represents the advanced form of AMD, which can cause irreversible vision loss. While treatment of wet AMD has evolved over the last decade, there are currently no therapeutic options for dry AMD. Imaging of the choroid, outer retina, and circulation may help us better comprehend the etiology and evaluate therapies for dry AMD. The ability to use imaging to correctly diagnose, monitor disease progression and the efficacy of new therapies, and predict prognosis is therefore very important. Various imaging modalities such as fundus photography, fundus autofluorescence, optical coherence tomography (OCT), OCT angiography, microperimetry, fluorescein angiography, and indocyanine-green angiography can be used in these evaluations and can help characterize drusen subtypes, GA, and choroidal anatomy. The most effective method to evaluate dry AMD may require incorporation of information from multiple imaging modalities to maximize the strength of each method.
Perspectives on reticular pseudodrusen in age-related macular degeneration
2016, Survey of Ophthalmology
Citation Excerpt :
Indocyanine angiography shows RPD as hypofluorescent dots in the mid to late phase of the angiogram, associated with impaired filling of the choroidal vasculature. These dots correspond to the dots observed on IR and FAF, suggesting a pathology internal to RPE.11,89,111,132 Fluorescein angiography is the least sensitive technique for detecting RPD lesions and may show a defect in choriocapillaries filling in the early phase.132
Drusen have been considered the clinical hallmark of age-related macular degeneration (AMD). Reticular pseudodrusen (RPD), although first described about 25 years ago, have only been recently recognized as an additional clinical phenotype of AMD with distinct characteristics on multimodal imaging and significant impact on visual function. Eyes with RPD are at greater risk of progression to advanced AMD when compared with eyes with drusen only. RPD can also occur in the absence of drusen. Unlike features external to the retinal pigment epithelium that have received most attention in AMD, evidence suggests that RPD are associated with changes internal to the RPE. Therefore, new avenues regarding the pathogenesis of AMD are highlighted by these recent observations. We summarize the current knowledge regarding the histology, imaging, and functional changes in eyes with RPD in AMD and offer concepts of future research for the AMD community to discuss.

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Supported by a grant of the Retina Research Foundation (Award of Merit in Retina Research 1996 Dr Coscas).

Reprint requests to Gabriel Coscas, MD, Clinique Ophtalmologique Universitaire de Créteil, 40 Av de Verdun, 94200 Créteil, France; fax: 33-1-45-17-5227; e-mail: [email protected]

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Indocyanine Green Angiography of Drusen

Purpose

Methods

Results

Conclusion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Relationship of drusen and abnormalities of the retinal pigment epithelium to the prognosis of neovascular macular degeneration

Arch Ophthalmol

The grading and prevalence of macular degeneration in Chesapeake Bay watermen

Arch Ophthalmol

Evolution of geographic atrophy of the retinal pigment epithelium

Eye

Aging and degeneration in the macular region: a clinico-pathological study

Br J Ophthalmol