Indocyanine green-mediated photothrombosis combined with intravitreal triamcinolone for the treatment of choroidal neovascularization in serpiginous choroiditis

Abstract

Purpose To report a case of peripapillary choroidal neovascularization (CNV) complicating serpiginous choroiditis that was treated by a single indocyanine green (ICG)-mediated photothrombosis session combined to intravitreous triamcinolone acetonide (TA) injection. Methods Interventional case report. A 48-year-old patient with peripapillary CNV was submitted to a laser-dye-mediated technique that uses ICG and low-intensity 810-nm light for continuous laser application; TA was then injected into the vitreous cavity 1 hour later, and prospective evaluation with fluorescein and ICG angiography as well as optical coherence tomography (OCT) was performed. Results At 2 weeks after treatment, bestcorrected visual acuity improved from 20/200 to 20/50, with further improvement to 20/20À1 in the subsequent 10 weeks. Absence of fluorescein leakage from the CNV and OCT evidence of resolved retinal oedema was observed at that time. Clinical stabilization was maintained up to 1 year of follow-up. There was no significant complication related to the procedure. Conclusion Combined ICG-mediated photothrombosis and intravitreous TA induced rapid and significant visual acuity recovery in this particular case of peripapillary CNV complicating serpiginous choroiditis. Accordingly, angiographic and OCT findings demonstrated neovascular lesion regression and restoration of the macular architecture.

Indocyanine-green-mediated photothrombosis (IMP) with intravitreal triamcinolone acetonide for macular edema secondary to group 2A idiopathic parafoveal telangiectasis without choroidal neovascularization: a pilot study

“…Intravitreal triamcinolone acetonide has been reported to be helpful in the management of IPFT, uveitic CME, exudative macular degeneration, diabetic macular edema, pseudophakic macular edema, and macular edema following central retinal vein occlusion [7][8][9][10][11][12][13][14][15]. Furthermore, the benefit from the combination of laserdye-mediated treatments (IMP and PDT) and IVTA has already been reported in different retinal-choroidal disease with improvement or stability of VA and fundus findings [4][5][6][16][17][18][19].…”

“…It has been postulated that its usefulness lies in anti-inflammatory effects and stabilization of the blood-retina barrier [10]. The benefit of the combination of laser-dye-mediated treatments [IMP and photodynamic therapy (PDT)] and IVTA has already been reported [16,17]. Recently, our group described that combined IMP and IVTA may provide stability or improvement in visual acuity and fundus findings in choroidal neovascularization secondary to age-related macular degeneration [18,19].…”

Management of Choroidal Neovascularization in Uveitis

“…78 Indocyanine green-mediated photothrombosis in combination with intravitreal triamcinolone has had successful results in the treatment of CNVMs in serpiginous choroiditis. 79 Resolution of CNVM in sympathetic ophthalmia was reported following treatment with cyclosporine. 80 Choroidal neovascular membrane formation can also occur in birdshot chorioretinopathy, acute multifocal placoid pigment epitheliopathy, toxoplasmosis (Fig.…”

Indocyanine Green Mediated Photothrombosis (IMP) with Intravitreal Bevacizumab (IVB) for Treatment of Choroidal Neovascular Membrane (CNV) due to ARMD

“…Currently, treatment with these agents requires multiple injections, leading to high cost and risk of systemic adverse events. 12 Indocyanine Green Mediated Photothrombosis (IMP) which uses low power diode laser augmented with Indocyanine green dye (ICG) has been successfully used in a variety of conditions [13][14][15][16][17][18][19][20][21][22][23][24][25][26] including subfoveal CNV due to ARMD. It causes selective intraluminal photothrombosis 27 and is much cheaper than PDT.…”