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Shalini Yalamanchi, Javier Zarranz-Vetura, Brenda Fallas, Thomas A. Albini, Janet L. Davis; Simultaneous Fluorescein and Indocyanine Green Angiography in Posterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2758.
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The objective of this study is to evaluate the usefulness of simultaneous fluorescein and indocyanine green angiography (FA/ICG) in the diagnosis and management of posterior uveitis.
Retrospective review of uveitis patients that underwent simultaneous heidelberg FA/ICG, which consists of a single injection and side by side comparative images, at Bascom Palmer Eye Institute between November 2008 to April 2010.
A total of forty two patients were evaluated; thirteen males and twenty nine females. Anatomic location of uveitis included anterior/intermediate (3), intermediate (2), posterior (19) and panuveitis (18). The specific diagnoses imaged were 7 birdshot chorioretinitis, 5 vogt koyanagi harada syndrome, 3 sarcoid panuveitis, 3 sympathetic ophthalmia, 2 intraocular lymphoma, 2 serpiginous choroidopathy, 2 tuberculous uveitis, 2 benign lymphoid hyperplasia, 2 autoimmune retinopathy, 1 multifocal choroiditis, 1 punctate inner choroiditis, 1 acute posterior multifocal placoid pigment epitheliopathy, and 11 miscellaneous. FA was positive in 88% (37) of patients, including 38% (14) retinal vascular leakage, 57% (21) subretinal hypo- or hyperfluorescent lesions, 24% (9) optic nerve leakage, 22% (8) macular leakage, .08% (3) associated choroidal neovascularization. ICG findings were present in 83% (35) patients, including 86% (30) subretinal hypofluorescent lesions, and .11% (4) with choroidal leakage. Both FA/ ICG were abnormal in 76% (32) of patients, and discordant in 11 cases. In 4 patients, lesions were only evident on FA or ICG and not clinically. Both FA and ICG were primarily abnormal in posterior uveitis (45%). Eight patients had follow up simultaneous angiography demonstrating response to treatment.
This study demonstrates that simultaneous FA/ICG provides diagnostic information in over seventy five percent of uveitis cases, and is most useful in the setting of posterior uveitis and panuveitis.
Tuberculous uveitis: Retinovascular leakage on FA and hypofluorescent lesions on ICGA.
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