Abstract
Purpose: :
Chronic macular edema remains a significant problem in diseases such as retinal vein occlusions and diabetic retinopathy. Such persistence may be due to the development of macroaneurysms. We report here that indocyanine green angiography (ICGA) may be more useful than FA for the detection of venous macroaneurysms.
Methods: :
Retrospective, noncomparative study. Fluorescein (FA) and ICGA of 25 patients with chronic (>12 months) macular edema due to branch (BRVO) or central retinal vein occlusion (CRVO) were compared. High resolution optical coherence tomography (HR-OCT) was used to confirm their diagnosis. Focal treatment of these macroaneurysms by laser photocoagulation was performed.
Results: :
Mean visual acuity was 0.94 LogMAR (range 0.2 LogMAR to 1.7 LogMAR). Macroaneurysms were seen in 64% of BRVO and 38% of CRVO. ICGA appeared more sensitive than FA for their detection, with 35% more macroaneurysms detected by ICGA, and a more clear delineation due to the absence of perilesional leakage. In all cases, HR-OCT confirmed the colocalisation of the area of dye pooling with a vascular structure, even in cases with no fluorescein pooling. Focal laser treatment of these macroaneurysms led to a significant decrease of macular thickness (432 to 286µ mean, p<0.05). Visual acuity showed a nonsignificant trend toward improvement.
Conclusions: :
Venous macroaneurysms are frequent complications of chronic macular edema following BRVO and CRVO. ICGA is more sensitive than FA for their detection, and may hence improve the number of patients that can be treated by laser photocoagulation. A randomized study is warranted to confirm these preliminary results.
Keywords: vascular occlusion/vascular occlusive disease • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • macula/fovea