J Korean Ophthalmol Soc.  2009 Jan;50(1):69-77. 10.3341/jkos.2009.50.1.69.

Changes of Choroidal Perfusion in Indocyanine Green Angiography After Photodynamic Therapy for Choroidal Neovascularization

• Lee H
• Kim SW
• Huh K

• KMID: 2211899
• DOI: http://doi.org/10.3341/jkos.2009.50.1.69

Abstract

PURPOSE: To evaluate the changes of choroidal perfusion after photodynamic therapy (PDT) documented by indocyanine green angiography (ICGA) and in pretreatment and posttreatment variables in patients with choroidal neovascularization (CNV) of age-related macular degeneration (AMD) and myopia (M).
METHODS
Eight eyes (seven patients) with CNV in M (Group 1) and 30 eyes (29 patients) with CNV in AMD (Group 2) were included among 38 eyes (36 patients) that underwent PDT. ICGA, fluorescein angiography, optical coherence tomography (OCT) for central foveal thickness were conducted. Changes of choroidal perfusion were graded on a five point scales based on the degree of choridal hypoperfusion in the early and late phases of ICGA.
RESULTS
Choriocapillary hypoperfusion was seen in 10 eyes among 30 eyes (33.3%) in group 2, but not in group 1 and the difference was statistically significant (p=0.002). However there is a limitation in confirming choroidal hypoperfusion owing to the thinning of both choriocapillaris and the RPE-Bruch's membrane complex in myopic CNV. In patients with CNV in AMD (Group 2), presence of choroidal hypoperfusion before PDT was accociated with the progression of hypoperfusion after PDT (p=0.001).
CONCLUSIONS
In CNV in AMD, presence of choroidal hypoperfusion before treatment seems to play a role in progression of hypoperfusion after treatment.

Keyword

Age-related macular degeneration; Choroidal hypoperfusion; Indocyanine green angiography; Photodynamic therapy

MeSH Terms

Angiography
Choroid
Choroidal Neovascularization
Eye
Fluorescein Angiography
Humans
Indocyanine Green
Macular Degeneration
Membranes
Myopia
Perfusion
Photochemotherapy
Tomography, Optical Coherence
Triazenes
Weights and Measures
Indocyanine Green
Triazenes

Figure

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  Figure 1. (A) Fundus photograph shows choroidal neovascularization and myopic conus. (B) Blocked fluorescence on fluorescein angiograph (FA) before photodynamic therapy (PDT) due to hemorrhage on choroidal neovascular component. (C) Choroidal neovascularization was identified on early Indocyanine green angiography (ICGA) before PDT. (D) Before PDT, there was no remarkable hypofluorescence on late ICGA. (E),(F) There was no change on fundus photograph and photograph of FA 3 months after PDT. (G) There was no significant change on early ICGA 3 months after PDT. (H) There was no significant decrease of fluorescence on late ICGA 3 months after PDT.

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  Figure 2. (A) Fundus photograph shows classic choroidal neovascularization in age-related macular degeneration. (B) large classic choroidal neovascular component shows early hyperfluorescence on FA before PDT. (C) Choroidal neovascularization was identified on early ICGA before PDT. (D) Before PDT, there was no remarkable hypofluorescence on late ICGA. (E) Fundus photograph 3 months after PDT. (F) Early hyperfluorescence disappeared on FA 3 months after PDT. (G) Early ICGA 3 months after PDT shows evident hypofluorescence. (H) Intensive hypofluorescence characterized by absence of choroidal perfusion markedly increased in size and intensity on late ICGA 3 months after PDT.

Reference

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