Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema

Abstract

Purpose: To evaluate the usefulness of indocyanine green angiography (ICGA) to detect leaking spots and the effectiveness of ICGA-guided focal laser photocoagulation in eyes with diabetic macular edema (DME). Methods: Ten eyes (8 patients) with diffuse DME diagnosed using fluorescein angiography (FA) and refractory to a sub-Tenon injection of triamcinolone acetonide (STTA), grid laser photocoagulation, or both were enrolled. FA and ICGA were performed using the Heidelberg Retina Angiograph 2. Hyperfluorescent spots on early-phase FA and on early- and late-phase ICGA were superimposed onto the macular thickness map measured by optical coherence tomography (OCT) and counted to calculate the spot density in the area with or without macular edema (ME). ICGA-guided focal laser photocoagulation was carried out. In 7 eyes, STTA was simultaneously performed. The central macular thickness (CRT) and macular volume (MV) were measured by OCT. Results: On early-phase FA, 4.8 ± 2.3 and 2.3 ± 1.5 hyperfluorescent spots/disk area were observed inside and outside the ME, respectively. In contrast, the spot density was significantly decreased to 1.8 ± 0.9 inside the ME and was only 0.3 ± 0.4 outside the ME on late-phase ICGA (p < 0.01). The mean follow-up period after ICGA-guided photocoagulation was 19.0 months. The mean best-corrected visual acuity improved significantly from 0.77 ± 0.34 logarithm of the minimum angle of resolution at baseline to 0.52 ± 0.37 at the last visit (p < 0.01). Both CRT and MV significantly decreased (p < 0.01). Recurrence of DME was observed in 4 eyes: 3 eyes were treatable only with STTA and 1 required additional ICGA-guided laser photocoagulation. Conclusions: ICGA may be useful to detect leaking spots responsible for DME, enabling less invasive focal laser photocoagulation even in some of the eyes with diffuse DME.

Detection rate of diabetic macular microaneurysms comparing dye-based angiography and optical coherence tomography angiography

“…Ogura and colleagues superimposed FA and ICGA images of MAs to guide focal laser treatment for macular edema. They adjudged ICGA to be helpful in finding leaking spots in CSME and probably even in diffuse edema 23 . Farias et al recently investigated the feasibility of ICGA in DR and distinguished between MAs smaller than 150 µm and telangiectatic capillaries 24 .…”

Microaneurysms cause refractory macular edema in branch retinal vein occlusion

“…Therefore, it is important not only for patients to have a lower treatment burden but also to have reduced medical expenses. We previously reported that indocyanine green angiography (ICGA)-guided laser photocoagulation was effective in idiopathic macular telangiectasia and diabetic ME 28 29 , both of which can cause ME due to microaneurysms. The same method might be applicable in patients with refractory ME in BRVO.…”

Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema

“…6 These have been reported in a variety of retinal vascular diseases among which retinal vein occlusion, Coat's disease and macular telangiectasia. [7][8][9][10][11][12][13][14][15][16] These lesions have received various terms in the literature, such as capillary macroaneurysms, [6][7][8][9][10]13,16 adult Coats' disease 11 or distant retinal vascular anomalies. 14 Since the term "macroaneurysm" creates confusion with arterial macroaneurysms, that Coat's disease is clearly a misnomer, and that he term "distant" is inappropriate because these may be found in the macula as well, we will use here the generic term telangiectatic capillaries (TCs).…”