High Speed ICG Angiography Case Study

This patient, a 92-year old white female, presented with a long history of glaucoma and macular degeneration, failing vision for 1-2 months, a best corrected visual acuity of 20/400 in the right eye, and hand motion in the left eye with an old macular scar.

High-speed indocyanine green angiography (HS-ICGA) was done in an attempt to reveal any feeder vessels. The Heidelberg Engineering SLO was used to acquire images at the rate of 12.3 frames per second following an injection of 0.3 ml of ICG dye (fluorescein angiography is typically done at one frame per second). This small amount of dye normally fades after twenty minutes, allowing another injection after laser treatment to see if the feeder vessel was successfully treated.

HS-ICGA was repeated 11 days later showing inactivity of the CNV membrane. A fluorescein angiogram done one month post-laser confirmed this. The patient's visual acuity at three months post-laser had improved to 20/100. Follow-up continues.

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Ophthalmoscopy of the right eye revealed pigment atrophy and localized pigment hyperplasia, with subretinal fluid present suggesting submacular choroidal neovascularization.

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Early FA: Classic subfoveal CNV membrane (arrow).

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Late FA: Spread of dye within serous elevation (arrow).

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Early HS-ICGA: Filling of choroidal and retinal vessels.

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Midphase HS-ICGA: Branching pattern of the subfoveal CNV membrane visible with single feeder vessel (arrow).

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Immediate post-laser HS-ICGA: Feeder vessel was successfully treated with dye red laser. CNV membrane does not fill with dye (arrow), fovea spared.

David V. Poer, M.D., F.A.C.S.

Retinal imaging by Thomas Egnatz, CRA