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Andrew Nam, Gloria Wu, Victor Chen, Vidhya Gunasekaran, Don Byongdo Kim, Kimberly Pham, Victoria Phan; ICG and FA Transit times in the Patient with Transient Sudden Visual Loss. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2774.
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Patients with transient, sudden visual loss (SVL) are referred to ophthalmologists and retinal specialists. Fluorescein angiography and indocyanine green dye studies may yield findings in blood flow transit times to aid in our understanding of this visual symptom.
Utilizing the EHR, eClinicalWorks and Heidelberg Spectralis HRA+OCT in a retina practice, we examined the transit times of fluorescein and indocyanine green (ICG) imaging.<br /> The CPT codes 92235 (FA) and 92040 (ICG) and ICD 9 codes 435.9 (unspecified transient cerebral ischemia), 433.10 (occlusion and stenosis of carotid artery without mention of cerebral infarction), and 369.9 (unexplained visual loss) were used to identify these SVL patients, Controls were identified by non retinal diagnostic ICD 9 codes. Inclusion criteria: Va = 20/15 to 20/50, combined FA/ICG studies with clear images. Exclusion criteria: poor quality of FA or ICG. Exclusion criteria: AMD, diabetes, glaucoma.<br /> The transit time recorded on the Heidelberg system, was noted at the first appearance of ICG dye as the short posterior ciliary artery circulation (SP1), the appearance of ICG in 4 quadrants of the eye (SP2), the first appearance of fluorescein dye, when the central retinal artery is seen, as FA1 transit and AV phase as FAV, in the primary study eye.
Of a total of 324 FA/ICG’s performed during 3/1/12 - 12/1/14, 15 pts met the inclusion criteria of SVL, and 8 controls (no AMD, DM , Glaucoma) . A total of 23 pts were included in the study. The transit times for the patient groups are recorded below in Table 1a. Table 1b shows age matched comparisons and p -values.
To our knowledge, this is the first study of early transit of ICG in evaluating SVL pts. The short posterior ciliary artery circulation is delayed with the SVL pts when compared to age matched controls. This study suggests that ICG data may provide additional data in assessing the patient with sudden visual loss. We hope this small study will encourage retinal specialists and ophthalmologists to evaluate ICG and FA transit times when examining their SVL patients.
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