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N Bouchenaki, L Cimino, A Resta, P Fontana, VT Tran, CP Herbort; Primary Inflammatory Choriocapillaropathies, a New Indocyanine Green Angiography Derived Concept . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4266.
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Purpose:The term of white dot syndromes is a pot-pourri classification including groups of unrelated clinical entities. In some of these diseases choriocapillaris dysfunction was susppected. Indocyanine green angiography (ICGA) allows visualization, through the RPE, of the choroidal vasculature including the choriocapillaris. We undertook to recategorize, with the help of ICGA, some of the diseases included in the ill-suited term of white dot syndromes. Methods: Patients seen at the above cited institutions, classified as white dot syndromes such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC) and by extension serpiginous choroiditis and intermediary forms between these entities were included. We excluded entities with a well defined pathology such as sarcoidosis, tuberculosis, VKH and birdshot chorioretinopathy. In addition all patients had dual fluorescein (FA) and ICGA, correlated with clinical findings and visual field testing when available at entry and on follow-up. Results: 6 patients with MEWDS, 5 patients with APMPPE and 3 patients with MC, one patient with serpiginous and 2 patients with intermediary forms such as ampiginous choroidopathy were included. In all patients the characteristic ICGA sign was choriocapillaris non perfusion appearing as hypofluorescent areas present throughout the angiographic sequence. Visual field defects were well correlated with the ICGA hypofluorescent areas, whereas it was badly correlated with FA signs. The evolution of choriocapillaris non-perfusion either towards chorioretinal atrophy or resulting in restitution of perfusion could be precisely monitored by ICGA but not FA. Conclusion: ICGA signs for choriocapillaris non-perfusion were found in all these entities,, as suspected in the pre-ICGA era indicating a common mechanism with diverse disease expressions. ICGA signs were also well correlated with visual function (visual field testing) and allowed to precisely monitor the perfusional state of the choriocapillaris, which was the case neither for fundus examination nor for FA, On the basis of the ICGA findings we suggest to regroup these entities under the term of primary inflammatory choriocapillaropathies
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