Indocyanine green angiography in posterior uveitis

Abstract

Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.

Annexure 1

Proforma for indocyanine green angiography in posterior uveitis

Annexure 2

Indocyanine green angiography Protocol

Figure 1

Active Serpiginous choroiditis (a) Color fundus photograph of the right eye showing presence of yellowish white subretinal confluent lesions radiating away from the disc sparing the fovea, (b) Transit phase FFA showing presence of confluent hypofluorescent lesions radiating away from the disc not involving the fovea with staining around these lesions, (c) Early phase ICGA showing presence of numerous confluent hypofluorescent lesions around the disc and surrounding the fovea, (d) Persistence of the hypofluorescent lesions with involvement of fovea with areas of loss of choriocapillaris on ICGA

Figure 2

Healed Serpiginous Choroiditis (a) Color fundus photograph of the right eye showing presence of peripapillary confluent pigmented chorioretinal atrophic lesions radiating away from the disc sparing the fovea, (b) Transit phase FFA showing presence of confluent hypofluorescent lesions radiating away from the disc not involving the fovea; there is presence of staining around these radiating lesions, (c) Early phase indocyanine green angiogram showing more number of hypofluorescent lesions as more as compared to clinical photograph and FFA, (d) Later phases of indocyanine green angiography demonstrates persistence of the hypofluorescent lesions with areas of loss of choriocapillaris

Figure 3

Ampiginous choroiditis

Figure 4

Acute multifocal posterior placoid pigment epitheliopathy

Figure 5

Multiple evanescent white dot syndrome (MEWDS)

Figure 6

Presumed tubercular choroiditis