Indocyanine green angiography of retinal pigment epithelial tears

To investigate the fluorescein and indocyanine green (ICG) features before and after retinal pigment epithelial tear.

Fluorescein and ICG videoangiography were performed in 30 patients affected by age-related macular degeneration either complicated by tear of the retinal pigment epithelium (25 eyes) or by pigment epithelial detachment with pretear characteristics (5 eyes).

At the pretear stage fluorescein angiography (FA) showed in all cases signs of occult CNV associated with delayed, slow and uneven filling of the pigment epithelium detachment. In 2 eyes the ICG filling of the retinal pigment epithelial detachment was seen. Progression to the tear stage was seen in 4 eyes where a CNV was evident on ICG angiography; in two eyes within one month after laser photocoagulation. At the tear stage FA showed an area of marked hyperfluorescence with well defined margins. Adjacent to the exposed area the torn RPE was markedly hypofluorescent during all angiographic phases. The bare choroid was always hypo or normofluorescent on ICG angiography. The torn retinal pigment epithelium showed moderate hypofluorescence. The exact seat and extension of CNVs could be visualized in 20 cases (67%; 95% C.I., 50-84%) with ICG angiography vs. 6 cases (20%; 95% C.I., 6-34%) with FA (p<0.001).

ICG angiography did not add anything substantial to the analysis of frank tears. The most useful application of ICG angiography in this disease is the visualization of the seat and extension of the associated CNV In fact, it is well known that laser treatment of a pigment epithelial detachment at the pretear stage may facilitate the development of a tear of the RPE.