April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Feasibility and Clinical Utility of Ultra-Widefield Indocyanine Green Angiography
Author Affiliations & Notes
  • Michael Klufas
    Ophthalmology, Weill Cornell Medical Colllege, New York, NY
  • Nicolas A Yannuzzi
    Ophthalmology, Weill Cornell Medical Colllege, New York, NY
  • Claudine E Pang
    Vitreous Retina Macula Consultants, New York, NY
  • Sowmya Srinivas
    Ophthalmology, University of Southern California - Keck School of Medicine, Los Angeles, CA
  • Srinivas R Sadda
    Ophthalmology, University of Southern California - Keck School of Medicine, Los Angeles, CA
  • K Bailey Freund
    Vitreous Retina Macula Consultants, New York, NY
    Ophthalmology, New York University School of Medicine, New York, NY
  • Szilard Kiss
    Ophthalmology, Weill Cornell Medical Colllege, New York, NY
  • Footnotes
    Commercial Relationships Michael Klufas, None; Nicolas Yannuzzi, None; Claudine Pang, None; Sowmya Srinivas, None; Srinivas Sadda, Carl Zeiss Meditec (C), Optos (C); K Bailey Freund, Heidelberg (C), Optos (C); Szilard Kiss, Optos (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 208. doi:https://doi.org/
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    • Get Citation

      Michael Klufas, Nicolas A Yannuzzi, Claudine E Pang, Sowmya Srinivas, Srinivas R Sadda, K Bailey Freund, Szilard Kiss; Feasibility and Clinical Utility of Ultra-Widefield Indocyanine Green Angiography. Invest. Ophthalmol. Vis. Sci. 2014;55(13):208. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To evaluate the feasibility and clinical utility of a novel non-contact scanning laser ophthalmoscope (SLO) based ultra-widefield indocyanine green (UWF-ICGA) angiographic system.

 
Methods
 

A retrospective review between 2009-2013 of consecutive patients that underwent imaging using a modified Optos® P200Tx (Optos PLC., Dunfermline, Scotland, UK) that produced high resolution images of the choroidal vasculature with up to a 200-degree field. UWF-ICGA was performed for a variety of conditions in order to assess utility for diagnostic purposes and treatment monitoring. Three experienced trained readers (SK, KBF, SRS) independently analyzed each UWF-ICGA image for the presence of retinal pathology.

 
Results
 

UWF-ICGA was performed on 138 eyes of 69 patients (30 males, 39 females). Mean age was 58 ± 16.9 years (range 24-85). High-resolution images of the choroidal circulation were obtained out to 200-degrees of the fundus in all eyes. The most common ocular pathologies imaged included central serous chorioretinopathy (CSCR, 24 patients), uveitis (16 patients) and age-related macular degeneration (AMD, 12 patients). A review of images revealed peripheral changes (outside the 50-60 degree view of standard ICGA imaging systems) on UWF-ICGA in 67.4% of eyes. Peripheral angiographic findings varied by condition and included dilated vessels, hyperfluorescence including choroidal neovascularization (CNV) with leakage, and hypofluorescence including vessel luminal filling defects.

 
Conclusions
 

The use of ultra-widefield imaging of the ocular fundus is rapidly expanding with significant implications for the diagnosis and treatment of vitreoretinal disorders. In our series of 138 eyes, SLO based UWF-ICGA was clinically practical and provided detailed images of both the central and peripheral choroidal circulation.

 
 
1-Neovascular AMD (A) Heidelberg (B) Optos autofluorescence showing mottled hyperautofluorescence consistent with drusen and hypoautofluorescence consistent with RPE atrophy. (C) Heidelberg FA/ICGA with CNV (arrows) on ICGA. (D) Optos UWF-ICGA shows excellent visualization of posterior pole choroidal hyperfluorescence consistent with CNV. Inset demonstrates macular quality is comparable to Heidelberg. (E) OCT showing subretinal and intraretinal fluid.
 
1-Neovascular AMD (A) Heidelberg (B) Optos autofluorescence showing mottled hyperautofluorescence consistent with drusen and hypoautofluorescence consistent with RPE atrophy. (C) Heidelberg FA/ICGA with CNV (arrows) on ICGA. (D) Optos UWF-ICGA shows excellent visualization of posterior pole choroidal hyperfluorescence consistent with CNV. Inset demonstrates macular quality is comparable to Heidelberg. (E) OCT showing subretinal and intraretinal fluid.
 
 
2-CSCR (A) Early Optos UWF-ICGA showing dilated vessels. (B) Late Optos UWF-ICGA showing hyperfluorescence corresponding to areas of dilated vessels in (A).
 
2-CSCR (A) Early Optos UWF-ICGA showing dilated vessels. (B) Late Optos UWF-ICGA showing hyperfluorescence corresponding to areas of dilated vessels in (A).
 
Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 550 imaging/image analysis: clinical • 452 choroid  
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