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William R Tucker, Nirali Bhatt, Monica D Dalal, Wendy M Smith, Dominic Obiyor, Robert B Nussenblatt, H Nida Sen; Indocyanine Green Angiography (ICGA) for the Detection of Disease Progression or Recurrence in Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5321.
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To report the longitudinal ICGA findings of non-infectious uveitis patients enrolled in a clinical trial.
Patients with an established diagnosis of intermediate, posterior or panuveitis entered a one-year prospective clinical trial. Uveitis had to be clinically quiescent at entry on high dose steroid therapy, which was then tapered to low dose with concomitant study medication. Unless contraindicated ICGA was performed alongside fluorescein angiogram (FA) at baseline and closure visits as well as at 5 follow-up study visits. ICGA was run with a standard protocol on a Heidelberg Spectralis and assessed for these recognized ICG characteristics of posterior uveitis; optic disc and early stromal choroidal vessel hyperfluorescence, choroidal vasculitis and hypofluorescent lesions during intermediate and late phases.
Thirty-one patients were identified, 2 patients could not receive ICGA due to allergy and were excluded from further analysis. Female:male split was 20:9 with a mean age of 45 years (range 19-64). Average uveitis duration was 67 months (range 3 -300). Among the 29 patients, 24 had posterior or panuveitis [5 birdshot chorioretinopathy (BCR), 5 Vogt-Koyanagi-Harada (VKH) disease, 10 sarcoidosis associated panuveitis, 4 idiopathic panuveitis] and 5 had intermediate uveitis (IU). All IU patients had normal baseline and follow-up ICGA. At baseline 24/24 posterior/panuveitis patients (100%) demonstrated hypofluorescent dark lesions/spots but no other characteristic ICGA findings. During steroid taper 20 of these 24 (83.3%) experienced an inflammatory flare detected on either clinical examination or FA while only 6 of the 24 (25.0%) (4 BCR, 1 VKH, 1 Sarcoid panuveitis) demonstrated an increase in ICGA hypofluorescent lesions at the time of flare. These changes were particularly dramatic in the BCR patients.
Confirming its utility in initial diagnosis ICGA demonstrated characteristic signs at baseline in the majority of posterior/panuveitis patients. Only in a minority of patients experiencing a clinically detectable disease flare over follow-up, did these hypofluorescent ICGA spots increase in size or number. This ICGA activity correlated with contemporaneous FA and clinical findings so that no disease recurrence or progression was detected with ICGA alone during this year long trial involving over 200 ICGA procedures.
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