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PurposeTo describe multimodal imaging features of choroidal osteoma (CO) complicated by choroidal neovascularization (CNV) and focal choroidal excavation (FCE).MethodsPatients presenting with CO and CNV between January and October 2016 were considered for this study. Diagnosis of CO was confirmed by ultrasound examination. All patients underwent multimodal imaging including optical coherence tomography (OCT), swept-source OCT angiography (DRI OCT Triton, Topcon, Inc., Tokyo, Japan) and fluorescein angiography (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany).ResultsTwo patients (one with bilateral CO) were included in the study. OCT showed a FCE in two eyes of two patients (one in correspondence of the CNV and the other adjacent to the CNV). OCT-A demonstrated presence of microvascular flow within neovascular network of the CNVs. Decalcification of the tumor was noted in correspondence of one eye with FCE.ConclusionsFCE may be found in eyes with choroidal osteoma and CNV. OCT-A was a valuable tool for detection of CNV complicating choroidal osteoma. Decalcification of choroidal osteoma may represent a common pathogenic pathway for development of FCE and CNV in choroidal osteoma.

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PURPOSE: To evaluate changes in macular morphology due to myopic choroidal neovascularization (CNV), using spectral-domain optical coherence tomography (SD-OCT). METHODS: In all, 22 eyes with recent-onset untreated CNV underwent 1 intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), followed by a pro-re-nata regimen. SD-OCT was performed at baseline (before first administration of anti-VEGF treatment) and month 1, and 2; macular morphologic changes and outer retina characteristics (SD-OCT findings) associated with CNV activity were evaluated. Sensitivity and specificity were calculated for SD-OCT findings using fluorescein angiography (FA) as standard reference. RESULTS: Mean central retinal thickness (CRT) showed no significant reduction from baseline (284±98 µm) to month 1 (257±74 µm) and month 2 (263±72 µm). A hyper-reflective lesion with fuzzy borders (fuzzy area), and 'absent or altered' IS/OS junction were the only SD-OCT findings associated with CNV activity (P<0.0001). Both these SD-OCT findings showed good sensitivity and specificity (95.1 and 96.0% (95% CI: 0.87-0.89), respectively, for the fuzzy area; 87.9 and 66.7% (95% CI: 0.65-0.87), respectively, for 'absent or altered' IS/OS junction) when compared with FA leakage (standard reference). CONCLUSIONS: Outer retina characteristics (ie, hyper-reflective lesion with fuzzy borders, and 'absent or altered' IS/OS junction) appear more meaningful than CRT in the evaluation of myopic CNV activity. These SD-OCT findings show overall good sensitivity and specificity when compared with FA leakage (standard reference), and could be considered as an alternative diagnostic tool to FA for myopic CNV monitoring.

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PURPOSE: To report a case of macular hole progression after intravitreal injection of triamcinolone acetonide (IVTA) for chronic macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: A 33-year-old woman with massive macular edema after CRVO underwent IVTA. Optical coherence tomography (OCT) and fluorescein angiography were performed before and after the procedure. RESULTS: At the 1-week IVTA injection control, the patient's best-corrected visual acuity improved from 20/400 to 20/200 and OCT detected a progression of macular hole stage. CONCLUSIONS: IVTA steroid injection may provide a significant improvement in macular edema, but injection-related complications may occur such as this uncommon macular reaction resulting in permanent visual loss.

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PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70.7%]). All eyes had either no or only a low-reflecting OCT signal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA. (Eur J Ophthalmol 2002; 12: 467-72).

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PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

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OBJECTIVE: To determine the natural course of well-defined plaque choroidal neovascularization (CNV) using indocyanine green angiography. METHODS: Two ophthalmologists, experts in macular diseases and indocyanine green angiography, examined 40 eyes with exudative age-related macular degeneration and a well-defined plaque CNV using complete ophthalmoscopic evaluation, fluorescein angiography, and indocyanine green angiography. The increase in the size of the plaques was analyzed using multivariate analysis, in relation to the worsening of visual acuity, with adjustment for age, sex, and length of follow-up. RESULTS: Mean follow-up was 13.5 months (median, 11 months). Initial and final mean visual acuity were 20/46 (median, 20/50) and 20/65 (median, 20/100), respectively. The mean initial size of the plaque was 6.62 mm2 (median, 6.20 mm2), and the mean final size was 10.40 mm2 (median, 9.76 mm2). The enlargement was statistically significant (P<.001). CONCLUSIONS: We found that plaque CNV tends to become larger with time, the enlargement reaching about 40% in 1 year of follow-up. The resulting loss of visual acuity, however, is not significant, and is slightly correlated with the extension of the lesion; it also does not appear to be directly related to sex.

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PURPOSE: To evaluate the efficacy of indocyanine green angiography (ICGA)-guided laser photocoagulation in eyes with fluorescein angiographic evidence of occult choroidal neovascularization (O-CNV) in patients with age-related macular degeneration (ARMD) with or without pigment epithelium detachment (PED). METHODS: Eighty eyes of 79 consecutive patients with O-CNV underwent laser treatment of a clearly outlined extrafoveal ICGA hyperfluorescent area, presumed to be focal CNV. Four types of presumed CNV were treated: Group 1 (20 eyes), CNV beneath the PED; Group 2 (23 eyes), CNV at the margin of the PED; Group 3 (10 eyes), parapapillary CNV and PED; and Group 4 (27 eyes), macular CNV without PED. Median follow-up was 17.5 months (range, 6-24 months). RESULTS: After 1 year, 15% of the eyes in Group 1, 30% in Group 2, 100% in Group 3, and 52% in Group 4 had obliteration of the presumed CNV. After 1 year, visual acuity was stable or improved in 18% of Group 1, in 37.5% of Group 2, in 100% of Group 3, and in 73% of Group 4. The remaining eyes worsened. CONCLUSIONS: Indocyanine green angiography-guided laser treatment may improve or stabilize visual acuity in some eyes with O-CNV. The best outcome is seen in eyes with presumed parapapillary CNV, probably made up of choroidal telangiectases in many cases. The type and location of the presumed CNV influence prognosis after laser treatment considerably. A randomized, controlled clinical study appears necessary to investigate the efficacy of ICGA-guided laser treatment in different types of presumed CNV. The inclusion criteria for further trials need to be defined with precision, as data from patients with different choroidal vascular abnormalities have been pooled until now.

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This study has been conducted to assess the sensitivity of indocyanine green angiography (ICGA) in detecting choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD) with occult CNV at fluorescein angiography (FA) and to establish their eligibility for laser photocoagulation. Three hundred eighty-three eyes of 355 consecutive patients with occult CNV at FA were studied by ICGA; occult CNV with or without pigment epithelial detachment (PED) were detected as well. Eligibility for laser treatment was established on the basis of the ICGA-guided CNV extension and localization. Out of 157 eyes (41%) with occult CNV and PED, 74 (47.1%) showed focal ICGA CNV, 35 eyes (22.3%) had plaque CNV. Thirty-five eyes with PED (22.3%) appeared serous without CNV, and in 13 eyes (8.3%) no CNV was detectable because of large hemorrhages. Out of the 226 eyes (59%) presenting occult CNV without PED, 94 eyes (41.6%) had plaque CNV, and 58 (25.7%) had focal CNV. In 74 eyes (32.7%), there was no detectable CNV or only an ill-defined ICGA appearance. ARMD with PED is closely associated with focal CNV, while plaque CNV is largely found in exudative ARMD without PED (p < 0.001). Considering all the cases examined by ICGA, CNV was evident in 261 eyes (68%) occult at FA. Extrafoveal CNV laser treatment was recommended for 103 eyes (27%). Our results suggest that ICGA may be useful in the diagnosis and management of ARMD with occult CNV at FA increasing the number of patients eligible for laser treatment.

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PURPOSE: To highlight the possible role of indocyanine green angiography in predicting future exudative changes in eyes that are candidates for drusen laser treatment. METHODS: In a 56-year-old woman, fluorescein and indocyanine green angiography were performed before drusen laser treatment. RESULTS: The treated eye had a suspicious lesion at baseline indocyanine green angiography and a nonsuspicious fluoroangiographic pattern. Seven months after treatment, the patient developed choroidal neovascularization and pigment epithelial detachment in the treated eye. CONCLUSION: To decrease the risk of macular exudative changes that may be related to laser treatment, eyes that are candidates for drusen laser treatment should be examined before treatment, not only by fluorescein angiography, but also by indocyanine green angiography.

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PURPOSE: To define the indocyanine green angiographic aspects of angioid streaks, peau d'orange and choroidal new vessels. METHODS: Fifty-seven consecutive patients (112 eyes) with angioid streaks were evaluated by fluorescein angiography and indocyanine green angiography. RESULTS: Indocyanine green angiography showed angioid streaks in all eyes. We identified three different indocyanine green patterns of streaks (four groups): fluorescent (63%), hypofluorescent (8%), 'track-like' (19%) and mixed (10%). Angioid streaks were visualized better by indocyanine green angiography and red-free retinography than fluorescein angiography. Peau d'orange was seen better and found to be more widespread by indocyanine green angiography. Fluorescein angiography visualized choroidal neovascularization better, except for occult forms. CONCLUSIONS: Our findings show that angioid streaks have different indocyanine green angiography patterns. Considering that the hypofluorescent pattern was significantly observed in younger patients, indocyanine green angiography aspects might be correlated with different stages of the disease.

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BACKGROUND: Informations are expected from the histopathological study of surgically excised choroidal neovascular membranes (CNMs), particularly in relation to the angiographic aspects of vascular architecture. METHODS: Fluorescein and indocyanine green (ICG) angiograms were studied together with the histopathological features of 12 surgically excised subfoveal CNMs in eyes affected by age-related macular degeneration (ARMD). RESULTS: Instead of the early and delayed diffuse hyperfluorescence secondary to CNMs observed on fluorescein angiography (seven were well defined, five scar evolved), ICG revealed (a) very early hypofluorescence of the membrane bulk over the fluorescence of the outer choroidal vascular bed and (b) late hyperfluorescence gradually increasing and partially defining the border of membranes. CNMs with well-defined hyperfluorescent aspects were characterized by fibrovascular bulk lined on one side by retinal pigment epithelium. Fibrosis reaction predominated over the vascular components in scar-evolved membranes. CONCLUSIONS: Fluorescein and ICG angiographic differences in the appearance of CNMs could depend on (a) the morphological structure and size of the CNM (b) its location within the chorioretinal layers and (c) different molecular characteristics of the dyes used.

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The natural prognosis of subfoveal neovascularization is severe visual acuity loss. Perifoveal laser photocoagulation is meant to spare a small portion of the central retina so as to possibly preserve foveal fixation. The aim of this retrospective study was to detect the persistence of central fixation and to evaluate the visual function of patients who had undergone perifoveal laser photocoagulation one year before, due to the presence of age-related macular degeneration with subfoveal neovascularization. The visual function was assessed by means of visual acuity (VA) measurement, central perimetry, scanning laser ophthalmoscope (SLO) scotometry and capability of using low-vision aids with success. Twelve eyes of 12 patients, 5 males and 7 females, with mean age 72.6 +/- 9.62 years, were included in the Study Group. Mean VA was 0.22 +/- 0.089 before laser treatment, 0.17 +/- 0.054 one week after laser treatment (p = 0.0152) and 0.13 +/- 0.063 one year after laser treatment (p = 0.045), with a statistically significant reduction of VA overtime (initial-final p = 0.0015). Mean lesion size was 2.12 +/- 0.528 disc diameters on the last follow-up fluorescein angiogram. One year after laser treatment, perimetry showed the persistence of central fixation in 2 eyes, while 10 eyes seemed to have lost it. SLO scotometry revealed central dot stimulus perception in 6 eyes and no central residual in 6 eyes. The SLO fixation plot showed persistence of central fixation also in 1 eye in which static perimetry had not detected it. The preferential retinal locus was located on the upper or upper-right margin of the lesion in 8 of the 9 eyes with paracentral fixation. All patients achieved a useful reading VA using low-vision aids, with 7.16 +/- 6.1 mean magnification power. The eyes with central visual residual on SLO scotometry had a final VA slightly higher than those without central residuals (VA 0.158 +/- 0.03 and 0.098 +/- 0.07, respectively), though the difference was not statistically significant (p = 0.0977).

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One hundred and fifty patients (300 eyes), mean age 49 +/- 15 years, with degenerative myopia underwent fluorescein and indocyanine green angiography (ICGA). Fluorescence of choroidal neovascularization (CNV) on ICGA was less evident than with fluorescein angiography (FA). FA revealed CNV in 98 eyes; ICGA showed CNV with different angiographic patterns in 82 eyes. ICGA permitted CNV diagnosis when retinal hemorrhages were present. ICGA allowed a more precise evaluation of lacquer cracks which appeared more numerous than the ones identified by FA. ICGA visualized the retrobulbar vasculature. This study shows that ICGA has a useful role for diagnosing and managing pathological myopia.

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Juvenile haemorrhagic choroidopathy (JHC) is an idiopathic syndrome marked by macular choroidal neovascularization (CNV) in patients under the age of 50. We used fluorescein angiography (FA) and indocyanine green angiography (ICGA) to examine 17 patients with macular CNV and JHC. CNV was always unilateral. On ICGA examination the CNV were weakly fluorescent in 59% of cases, hyperfluorescent in the remaining 41%. ICGA showed up the following alterations: a) areas with diffuse choroidal hyperfluorescence at the posterior pole or in the peripapillary region in 11 affected eyes (65%), in the fellow eye too in 5 patients; b) areas of choroidal hypofluorescence at the posterior pole but also outside the vascular arcades in 2 affected eyes (12%). In conclusion, ICGA does not appear indispensable for detecting CNV in JHC but this method does show up diffuse choroidal alterations not detectable with FA. The pathogenetic implications of the ICGA findings are discussed.

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Juvenile macular detachment of the retinal pigmented epithelium is rarely seen clinically. Single or multiple detachments can occur and are due to the accumulation of liquid in the subretinal space. The natural history of the disease, which usually affects young people, has not yet been defined. We examined and followed 19 eyes of 15 patients affected by macular juvenile serous detachment of the retinal pigment epithelium, not associated with other retinal disturbances. The patients were followed for a mean period of 12 months (range 6-33 months). The mean age was 48 years (range 40-59 years): 7 patients were male and 8 female. Mean initial visual acuity was 8/10 (range 1/10-10/10) and mean final visual acuity was 9.2/10 (range 6/10-10/10). Detachment of the retinal pigmented epithelium was unchanged in 58% of cases, decreased or disappeared in 37% of cases and increased in 5% of cases. These results indicate that the natural course is usually good and photocoagulation is not necessary.

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