ABSTRACT.Purpose: The iris vasculature shows typical changes in pseudoexfoliation syndrome (PXS) revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels. Iris indocyanine green angiography (IICGA) can visualize more precisely details of the iris vascular pattern, especially as regards hypoperfusion and capillary dilatations. The aim of the present study is to describe the angiographic features of PXS on IFA and IICGA, comparing eyes affected with those not affected by capsular glaucoma. Methods: In a prospective study 42 consecutive patients affected by PXS underwent a complete ophthalmologic examination including IFA and IICGA. Thirty-two eyes were affected by capsular glaucoma. IICGA was performed using IMAGEnet System H1024. Results: IFA can easily detect the microneovascularisation, whereas IICGA allows a better recognition of iris hypoperfusion and anastomotic vessels, and it can reveal iris pigment epithelium defects. While the degree of hypoperfusion was similar in the two subgroups, eyes affected by capsular glaucoma more frequently showed signs of both microneovascularisation (marked stromal tufts and marked plexi), and of anastomotic vessels (peripheral loop, lesser circle and oblique vessels), with statistically significant difference. A clear correlation between hypoperfusion, microneovascularisation, and anastomotic vessels as regards site and extent was not noticed. Conclusions: A different angiographic pattern can be detected in PXS eyes with capsular glaucoma in comparison with eyes without it. Further studies are needed to correlate angiographic features revealed by IFA and IICGA, with clinical features.Key words: pseudoexfoliation syndrome -iris fluorescein angiography -iris indocyanine green angiography.

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Background Precise evaluation of the iris vascular pattern in pseudoexfoliation syndrome (PXS) may be difficult with iris fluorescein angiography (IFA) because of the frequent presence of a heavily pigmented iris and conspicuous late leakage. However, iris indocyanine green videoangiography (IICGV) can precisely visualize details of the iris vascular pattern. This study analyzed the utility of IICGV in detecting microvascular changes in PXS and compared these findings with those of IFA. Methods Twenty-eight patients with PXS in both eyes underwent an ophthalmic examination including IFA and IICGV. IICGV was done with the IMAGEnet system H1024. Results IICGV gave better visualization of iris hypoperfusion and anastomotic vessels whereas iris microneovascularisation was far more clearly visible on IFA. IICGV also detected iris pigment epithelium defects. Conclusions IICGV can be considered a useful tool for evaluation of the iris vascular pattern in PXS. Iris hypoperfusion did not appear to contribute to the development of iris microvascular changes.

The occurrence of macroaneurysms as a consequence of central retinal vein occlusion was previously reported in one study only with the appearance of a single capillary macroaneurysm. We report a case of central retinal vein occlusion presenting several capillary macroaneurysms. It may be supposed that retinal ischemia plays an important role in the pathogenesis of capillary macroaneurysms, in association with the pressure increase in the capillary network due to venous obstruction.

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