Shiraga F, Shiragami C, Matsuo T, Yokoe S, Takasu I, Ohtsuki H
Department of Ophthalmology, Okayama University Medical School, Japan.
Ophthalmology. 2000 Mar;107(3):600-7. doi: 10.1016/s0161-6420(99)00126-8.
This study aimed to determine whether indocyanine green (ICG) angiography is useful to identify the ingrowth site of idiopathic choroidal neovascularization (CNV), which can predict visual outcomes after surgical removal of idiopathic CNV.
Consecutive, observational case series.
Twenty-six patients with idiopathic subfoveal CNV, of whom six underwent submacular surgery.
Indocyanine green videoangiography with a scanning laser ophthalmoscope.
We studied ICG videoangiographic images of choroidal neovascular membranes from the early phase to the late phase with special attention to abnormal findings, which can indicate the ingrowth site of CNV.
Early ICG angiography demonstrated distinct neovascular vessels in 24 of the 26 patients (92%). Hypofluorescent rims continuously or intermittently surrounded neovascular membranes on late ICG angiograms in 21 of the 26 patients (81%). In 22 of the 26 patients (85%), ICG angiography demonstrated hypofluorescent areas within the CNV. These hypofluorescent areas frequently became ring shaped in the middle to late phase of the ICG angiography. In 14 of 16 patients (88%) with CNV larger than half a disc area, the filling of neovascular vessels appeared from the inside of the hypofluorescent areas and branched out toward the surrounding hyperfluorescent membrane in the early phase. In all six patients who underwent surgical removal of CNV, ICG videoangiography showed these hypofluorescent areas from which neovascular vessels emanated. Three of the four surgical patients, in whom hypofluorescent areas or central fluorescent areas surrounded by ring-shaped hypofluorescence were extrafoveal or juxtafoveal, had a best postoperative visual acuity of 20/60 or better. In contrast, both surgical patients with subfoveal hypofluorescent areas had a best postoperative visual acuity of 20/70 or worse.
Although further observations are needed, ICG angiography may be a useful adjunct in the identification of the ingrowth site of idiopathic CNV, which can predict visual outcomes after surgery.
本研究旨在确定吲哚菁绿（ICG）血管造影是否有助于识别特发性脉络膜新生血管（CNV）的生长部位，这可以预测特发性CNV手术切除后的视力结果。
连续观察病例系列。
26例特发性黄斑下CNV患者，其中6例接受了黄斑下手术。
使用扫描激光检眼镜进行吲哚菁绿视频血管造影。
我们研究了脉络膜新生血管膜从早期到晚期的ICG视频血管造影图像，特别关注可提示CNV生长部位的异常表现。
早期ICG血管造影显示26例患者中有24例（92%）有明显的新生血管。26例患者中有21例（81%）在晚期ICG血管造影中，新生血管膜周围持续或间歇性出现低荧光边缘。26例患者中有22例（85%）ICG血管造影显示CNV内有低荧光区。这些低荧光区在ICG血管造影的中晚期常呈环形。在16例CNV大于半个视盘面积的患者中，有14例（88%）在早期新生血管的充盈从低荧光区内开始，并向周围高荧光膜分支。在所有6例接受CNV手术切除的患者中，ICG视频血管造影均显示有这些发出新生血管的低荧光区。4例接受手术的患者中，有3例低荧光区或被环形低荧光包围的中央荧光区位于黄斑外或黄斑旁，术后最佳视力为20/60或更好。相比之下，2例黄斑下有低荧光区的手术患者术后最佳视力均为20/70或更差。
尽管需要进一步观察，但ICG血管造影可能是识别特发性CNV生长部位的有用辅助手段，这可以预测手术后的视力结果。
