Chapter 4a
Indocyanine Green Angiography
Eric D. Weichel, Carl D. Regillo and Joseph I. Maguire
Main Menu   Table Of Contents



Because of the limitations of fluorescein angiography (FA) in imaging the choroidal circulation and associated pathology, investigators have searched for alternative dyes to improve choroidal angiography. The most promising has been indocyanine green (ICG) dye. Although ICG angiography (ICGA) has been performed for more than 30 years, it has not been until relatively recent, with technologic advances in high-resolution digital imaging systems or scanning laser ophthalmoscopes (SLO) together with infrared-sensitive video cameras, that the potential clinical advantages of ICG dye over sodium fluorescein were finally demonstrated.1–4

Investigations with ICGA and ocular applications date back to 1970 when Kogure et al.5 performed intra-arterial choroidal absorption angiography in monkeys. The quality of the images, using false-color infrared film along with the route of administration, limited this technique's usefulness. Reports describing intravenous injection of the dye and the use of black and white infrared film for absorption angiography followed.6 These changes allowed easier, more consistent angiograms. In 1973, Flower and Hochheimer7 described a method of ICG fluorescence angiography, providing improved resolution of the choroidal vasculature compared with absorption angiography.

Although a variety of fundus conditions were subsequently studied using ICG fluorescence angiography, clinically useful choroidal images remained elusive due to the limited ability of available systems to enhance low ICG dye fluorescence.8 In 1986 Hayashi et al.9 reported the use of an infrared-sensitive video camera to perform ICGA. Compared to prior film studies, videoangiography, along with improvements in illumination and excitation-barrier filter separation, advanced image quality.

Numerous reports followed indicating a potentially significant advantage of ICGA over FA in imaging choroidal pathologic processes. In 1989, Destro and Puliafito1 demonstrated improved visualization of choroidal neovascularization (CNV) using ICGA compared with FA in selected cases. They also introduced the concept of late imaging, whereby images obtained after clearing of ICG dye from the choroidal circulation show persistent hyperfluorescent pathology against a dark background.

The use of higher-resolution digital monitors (1024-line) coupled with infrared-sensitive video cameras, described by Guyer et al.3 and then Yannuzzi et al.4 in 1992, provided even better images. ICG enhanced visualization of choroidal lesions, such as CNV, compared with FA was consistently obtained in several large clinical series.4,10,11 Similar ICGA diagnostic yields in the setting of exudative macular degeneration were also obtained by investigators using SLO systems.12,13

Back to Top
Indocyanine green (C43H47N2O6S2Na) is a water-soluble tricarbocyanine dye with a molecular weight of 775 daltons.14,15,16 Initially used in cardiac and liver function tests, ICG's clinical utility in fundus angiography results from its spectral properties in the near-infrared range.3,8 Compared with sodium fluorescein, whose peak absorption and emission is in the visible spectrum, ICG has a peak absorption in serum between 790 and 805 nm and a peak emission at 835 nm.14,17,18 These spectral properties result in excellent penetration of the retinal pigment epithelium, macular xanthophyll, other ocular pigment, and even blood, allowing superior viewing of the choroidal vasculature. Since longer wavelengths undergo less scatter than shorter wavelengths, visualization through media opacities is improved as well.

ICG is more highly bound to blood proteins than sodium fluorescein. Nearly 98% of circulating ICG is bound to various serum proteins, such as albumin and a-lipoprotein.15,19,20 (Fluorescein dye is only 60% to 80% protein bound.) This high degree of binding and possible preferential binding to high–molecular-weight lipoproteins may explain the dye's apparent poor penetration of capillary fenestrations in the choriocapillaris. This tendency of ICG to remain intravascular facilitates visualization of the choroidal vasculature.15,19,20

After intravenous injection, ICG is rapidly eliminated by the liver and exhibits minimal uptake in the peripheral tissues. ICG is not chemically altered in the liver and has been recovered in the bile unchanged.15,21 There is no apparent reabsorption in the bowel. The dye is not detected in the cerebrospinal fluid and does not appear to cross into the placental circulation.22

Back to Top
ICGA is a relatively safe procedure with few reported adverse reactions over 20 years of clinical use in different areas of medical practice. The early nonophthalmic literature reported rare adverse effects such as urticaria, chills, hypotension, and dyspnea with a relatively large portion of the cases in patients with either iodine allergies or uremia.23 Two deaths were also reported in this review, with both cases in the setting of cardiac catheterization; a causal relationship to the dye itself was unclear.

In the ophthalmic literature, a comprehensive analysis revealed seven reactions in a consecutive series of 1923 ICGA procedures performed in 1226 patients.24 These reactions included nausea and vomiting in two cases, urticaria in two cases, vasovagal reactions in two cases, and acute hypotension in one case. This represents a 0.3% adverse reaction rate for ICGA. A review of the literature from this report identified 18 severe reactions and 3 deaths. With approximately 1 million doses sold at that point, a 1 in 333,333 incidence of death was estimated. There have been two additional cases of anaphylactic shock following ICGA.25,26 In comparison, FA has an estimated adverse reaction rate of between 2.7% and 11.7% along with a death rate of approximately 1 in 222,000 angiograms27; therefore, ICGA appears to be a safer test.

Given the chemical characteristics and pharmacodynamics along with the profile of patients who experienced some of the more serious adverse reactions associated with the use of ICG dye, ICGA is contraindicated in patients with iodine or shellfish allergies, liver disease, and end-stage renal disease. It should also be avoided in pregnancy at this time, given the lack of human toxicity data in this area.28 Extravasation of the dye causes local tissue irritation and can produce tenderness, but no significant permanent tissue damage has been reported.

Back to Top
The fundus cameras used for ICGA are modified to include antireflective coatings and filters for maximal transmission of infrared wavelengths and to allow widening of the camera aperture to increase the amount of infrared light entering the camera. The images obtained with these modified cameras also allow color fundus or fluorescein angiogram images.

Digital imaging cameras are similar to 35-mm film cameras. Instead of a shutter and exposure of a silver-based film, an electromechanical shutter opens, sending light to a computer coupling device (CCD) containing light-sensitive elements called pixels. The camera then converts the analog signal to a digital signal and stores the image in a hard drive for immediate viewing. The CCD in an ICG camera is designed to sense infrared light wavelengths. The images are captured at one frame per second and displayed on a high-resolution video monitor. The stored images are then printed as hard copies or saved as digital files. The combination of an infrared light-sensitive camera with a digital imaging system allows high-resolution (1024 line) images needed for useful clinical ICG angiography. Computer software also allows clinicians to digitally enhance the ICGA images. These contrast-enhanced angiograms allow for higher diagnostic yield when compared to nonenhanced images.29

Back to Top
The scanning laser ophthalmoscope uses a small laser beam to scan across the retina. The light reflected from this illuminated spot is detected and electronically coded for image generation. The confocal SLO places a small pinhole aperture in the plane conjugate to the focus plane, thereby removing any scattered and reflected light from outside of the focal plane while improving contrast sensitivity and image contrast.31 The advantages of the confocal SLO over fundus camera images include, but are not limited to, superior resolution at a focal plane of a particular depth and imaging through small pupils and media opacity.31

Two confocal scanning high-speed infrared laser ophthalmoscopes are being used in clinical practice (Heidelberg Retina Angiograph (HRA), Heidelberg Engineering GmbH, Heidelberg, Germany, and Rodenstock SLO, Canon, Tokyo, Japan). The high-speed ICGA (HS-ICGA) HRA allows frame capture up to 20 frames per second. Due to the confocal system and laser illumination, the HRA detects faint hyperfluorescence and digitizes with high pixel resolution. These 30-degree field-of-view images are usually obtained in the transit phase of the ICGA after a 0.3 mL bolus of ICG injected rapidly after a 5-mL saline flush. This imaging system allows high resolution and evaluation of vessels with a diameter of 50 microns.

Gelisken et al.32 examined 100 consecutive occult CNV patients with SLO versus high-resolution digital fundus ICGA. They found that the SLO was superior in detecting well-defined vessel structure, whereas the digital fundus camera best detected focal hyperfluorescent spots and late-appearing plaques.

Back to Top
From a clinical standpoint, ICGA using a digital video system can be grossly divided into early, middle, and late phases. Although SLO-based ICGA can be similarly described, investigators using this technique have concentrated more on the earlier images.12,13 Therefore, the features of a standard ICG videoangiogram based on recent studies using the standard 1024-line digital systems will be described.3,4,11

The “early” phase (0–3 minutes after injection) encompasses the period from the first appearance of ICG dye in the choroidal arterial circulation to the point of maximal ICG choroidal hyperfluorescence, usually occurring within the first minute after the injection of dye (Fig. 1A). During this phase, both medium and large choroidal arteries and veins are well visualized beneath the hyperfluorescent retinal vasculature. Individual choriocapillaris vessels cannot be distinguished. The areas surrounding middle and large choroidal vessels appear relatively hypofluorescent. This “pseudohypofluorescence” is, at least in part, a result of a smaller volume of blood in the choriocapillaris compared with the larger vessels, with the illumination intensity adjusted for the strongest portion of fluorescence.

Fig. 1 Normal Indocyanine Green (ICG) angiogram. A. Early phase photograph (90 seconds after dye injection) shows the hyperfluorescent choroidal and retinal vessels. B. Middle-phase photograph (10 minutes after dye injection) reveals more homogeneous background choroidal fluorescence with relative attenuation of the retinal vascular fluorescence. C. Late-phase photograph (30 minutes after dye injection) shows medium-sized choroidal vessels in relief (relative hypofluorescence). No retinal structures are visible.

In the “middle” phase of the angiogram (5–15 minutes after injection), the choroidal veins become less distinct as a nearly homogeneous, diffuse choroidal fluorescence emerges (see Fig. 1B). The fluorescence from the retinal vessels also begins to attenuate. Lesions that demonstrate abnormal hyperfluorescence on ICGA typically begin to stand out in contrast to the fading surrounding normal background fluorescence by this point in the study.

In the “late” phases (beyond 18–22 minutes), all details of normal retinal and choroidal vessels are lost as the hyperfluorescence fades even further (see Fig. 1C). The choroidal vessels now stand out in relief as hypofluorescent channels and retinal vessels are no longer visible, and the optic nerve head is dark. There is maximal contrast with any abnormal hyperfluorescent lesions. The edges of such lesions may exhibit some “fuzziness” at this stage, apparently from limited dye leakage.

For the standard ICGA, 25 mg (12.5 to 50 mg) of ICG dye in the manufacturer's diluent is administered intravenously in a bolus fashion, similar to intravenous fluorescein angiogram protocols. Images are typically obtained at several second intervals until the retinal and choroidal circulations are maximally hyperfluorescent and then at approximately 30- to 60-second intervals for the first few minutes of the study to capture images through the early phase of the angiogram. Subsequent images are typically taken between 8 and 12 minutes for the middle phase and then between 18 and 25 minutes for the late phase. Most importantly, abnormal ICG hyperfluorescence is sufficiently identifiable by 25 minutes, but, occasionally, images obtained 30 to 40 minutes into the study are helpful. To image retinal and choroidal vessels in the late phase of the angiogram, a technique of reinjecting a small amount of ICG dye at 30 to 40 minutes into the study has been described.33

The available software packages of most digital videoangiogram systems have image-enhancing and image-tracing capabilities. Limited improvement of image contrast can be obtained with various enhancement techniques. The ability to align and superimpose images and tracings (“warp tracing”) can be helpful in determining the location or size of a particular angiographic finding, with respect to other anatomic structures (Fig. 2).4,11

Fig. 2 An example of “warp tracing.” A. The hyperfluorescent lesion seen on ICGA is encircled. B. The tracing is shown superimposed onto the previously aligned, corresponding red-free image.

Back to Top
In general, the most promising clinical application of ICGA is as an adjunct to FA in the diagnosis and management of exudative age-related macular degeneration (AMD).2–4,11,12,13 ICGA may also be of value in evaluating other choroidal-based pathologic processes, such as choroidal tumors, central serous chorioretinopathy, and choroidal inflammatory or degenerative diseases.9 ICGA has been used in various ways to study choroidal vascular flow, and the technique, in general, may be helpful in elucidating the pathophysiology of diseases involving the choroidal vasculature.8,37,39–43
Back to Top


In AMD, it has long been postulated that focal choroidal ischemia may play a role in the development of CNV. Macular choroidal vascular “watershed” zones have been known to exist, but their causal relationship to CNV has never been determined. On ICG angiography, these presumed watershed zones appear as areas of relative, abnormal hypofluorescence in the early phases of the angiographic study.44 A published ICGA analysis by Ross et al.45 revealed a much higher incidence of the presumed watershed zones in the macula of eyes with AMD compared with age-matched control eyes (55% vs. 15%, respectively). Furthermore, Goldberg et al.46 found that 92% of eyes that developed choroidal neovascular membranes had watershed zones. These data support the notion that watershed zones play a role in CNV development and that ICG angiography may be useful once again in identifying eyes at the highest risk for the exudative transformation. Other studies have shown that ICGA can distinguish the different types of drusen and, therefore, may be useful to evaluate the risk of progression of AMD.47


Classic CNV as determined by FA shows a similar appearance on ICGA with well-defined hyperfluorescence throughout the transit phase and leakage obscuring the borders of the lesion in the late frames. However, the leakage in the late frames tends to be less pronounced with ICGA. Overall, ICGA offers no advantage over fluorescein angiography in this setting.


Occult CNV assumes a variety of FA patterns.48 There can be obscuration of the neovascularization from fluorescein blockage by overlying fluid or pigment or from rapid leakage of the dye in the area of interest. Sometimes there is slow, irregular fluorescein leakage with poorly delineated borders. With occult CNV, there may be varying degrees of uncertainty as to the precise location and extent of the choroidal neovascular membrane using FA alone.

Both fluorescein and ICG dyes appear to be retained by CNV and will, therefore, exhibit hyperfluorescence relative to surrounding tissue.1 ICGA theoretically provides enhanced visualization of CNV in this setting because the ICG infrared fluorescence better penetrates pigment and fluid than the visible light fluorescence of sodium fluorescein, and the highly protein-bound ICG dye leaks less from abnormal vessels compared with fluorescein dye as described earlier. Several patterns of ICG hyperfluorescence for occult CNV have been observed.4,11,49,50 These include early-appearing small hyperfluorescent spots (hot spots), plaque-like hyperfluorescence, collections of abnormal vessels, and late-appearing hyperfluorescence with indistinct edges (Figs. 3, 4, and 5). A combination of these patterns can be seen. Although thin blood is easily penetrated by the infrared fluorescence (Fig. 6), thick blood will still obscure the underlying choroidal pattern to some degree. Reichel et al.51 demonstrated that ICGA was superior to fluorescein angiography in determining the extent of CNV secondary to age-related macular degeneration obscured by hemorrhage.

Fig. 3 A. Late-phase fluorescein angiogram shows ill-defined leakage in the central macular area of an eye with macular degeneration. B. The corresponding late-phase (23-minute) ICG angiogram reveals a discrete hyperfluorescent spot in the macula.

Fig. 4 A. Arteriovenous phase fluorescein angiogram taken from a patient with macular degeneration shows leakage in the central macula along with surrounding ill-defined, speckled hyperfluorescence. B. The corresponding late-phase (25-minute) ICG angiogram demonstrates a well-defined, plaque-like area of relative hyperfluorescence. (Courtesy of Dr. W. Annesley)

Fig. 5 A. Ill-defined late leakage and mottled hyperfluorescence along with blockage of fluorescence from subretinal hemorrhage is evident temporal to the foveal center in this fluorescein angiogram of a patient with macular degeneration. B. The corresponding late-phase (22-minute) ICG angiogram shows a bright, well-delineated hyperfluorescent vascular-like structure in the central macula. (Courtesy of Dr. W. Benson)

Fig. 6 A. Arteriovenous phase fluorescein angiogram reveals a hypofluorescent area just temporal to fixation representing blockage from subretinal hemorrhage. Ill-defined hyperfluorescence is also seen along the nasal and inferior border of the blocked fluorescence, suggesting occult choroidal neovascularization in a patient with macular degeneration. B. A middle-phase (10-minute) ICG angiogram of the same eye demonstrates a discrete abnormal focus of relative hyperfluorescence corresponding to the area of subretinal hemorrhage. In contrast to the fluorescein angiogram, neither the thin layer of hemorrhage nor the fine drusen is evident on the ICG angiogram.

Several investigators have demonstrated the ability of digital ICG angiography to not only confirm, but also better delineate CNV in certain cases of exudative AMD.1,3,4,10–13,33 Early large series by Yannuzzi et al.4,52 and Regillo et al.,11 using digital videoangiogram systems demonstrated well-defined hyperfluorescent foci of ICG presumably corresponding to the entire choroidal neovascular process in approximately 40% of cases, where FA revealed occult or ill-defined CNV only (see Figs. 3, 4, 5, and 6). A similar yield was reported early on by Kuck et al.,13 using SLO-based ICGA.

Furthermore, studies by Regillo et al.,11 Sorenson et al.,53 and Guyer et al.54 have shown that laser photocoagulation of well-defined ICG hyperfluorescent foci with treatment guided solely by the ICGA findings resulted in short-term resolution of exudation and stabilization or improvement of vision in 56% to 69% of cases. Although prior studies with AMD patients have shown that occult or ill-defined CNV on FA have, in general, a poor visual prognosis,55,56 adequate controls are not available to determine whether laser therapy as outlined in these studies significantly altered the natural history. Nonetheless, the data suggest that treatment based on ICGA findings may result in prompt resolution of exudation and improved visual acuity in selected cases. Therefore, this technique has the potential to increase the yield of exudative AMD cases that may be effectively managed by conventional laser photocoagulation treatment methods.


In contrast to the bright hyperfluorescence on FA, serous pigment epithelial detachments most often appear either isofluorescent or slightly hypofluorescent; associated hyperfluorescent CNV is, therefore, more easily seen on ICGA (Fig. 7). In AMD, a serous pigment epithelial detachment (SPED) is usually associated with CNV. However, the CNV may not be adequately visualized with fluorescein angiography because of rapid fluorescein pooling into the sub-pigment epithelial space. With ICGA, the neovascular component shows a relative hyperfluorescence, whereas the serous component of the complex is isofluorescent or hypofluorescent due to the minimal amount of ICG leakage(Fig. 7) It was initially hoped that this would lead to an increased yield of successful laser treatment of such lesions. Baumal et al.57 demonstrated that ICGA revealed CNV associated with SPED in 83% of eyes in which the CNV was not well delineated by fluorescein angiography. However, laser treatment to the presumed neovascular focus as guided by the ICGA findings did not change the visual outcome compared to controls. Lim et al.58 showed a transient stabilization of visual acuity following ICGA-guided laser photocoagulation for CNV associated with SPED. However, the treatment benefit diminished with time. The collective experience of Retina Service members at Wills Eye Hospital indicate that most eyes with SPED do not seem to benefit from treatment, although there are occasional dramatic, favorable results. This is especially true if the neovascularization on ICG angiography is small and located at the edge (rather than within) of the SPED.44

Fig. 7 A. Arteriovenous phase fluorescein angiogram shows a bright, homogeneous hyperfluorescent area typical of a serous pigment epithelial detachment located temporal to the foveal center. The truncated nasal border of the detachment along with the adjacent mottled hyperfluorescence is suggestive of associated occult choroidal neovascularization in this patient with macular degeneration. B. The corresponding late-phase (20-minute) ICG angiogram reveals a bright hyperfluorescent area superotemporal to fixation (arrow) presumably representing the underlying choroidal neovascularization. The adjacent hypofluorescent serous pigment epithelial detachment (arrow heads) is seen in contrast. (Courtesy of Dr. E. Shakin)


ICGA may be a useful adjunct to FA in determining the presence or extent of recurrent CNV.4,11,53 Photocoagulated areas on ICGA are completely hypofluorescent, and, compared with FA, there is greater contrast between the photocoagulated site and any associated persistent or recurrent CNV (Fig. 8). Preliminary data reveal a good correlation between treatment success and the lack of any residual abnormal ICG hyperfluorescence, indicating that the ICGA may accurately identify the presence of CNV.11,53 This is further supported by a human clinicohistopathologic study in which a well-delineated plaque of hyperfluorescence on the ICGA corresponded precisely with abnormal subretinal pigment epithelial fibrovascular tissue identified by histopathologic examination of serial sections.59 Regillo et al.60 evaluated persistent and recurrent choroidal neovascularization and found ICGA to improve visualization of ill-defined choroidal neovascular complexes seen on fluorescein angiography. However, ICGA was not useful when evaluating post-treatment fluorescein angiograms negative for any CNV or when the FA showed well-defined CNV.

Fig. 8 Early phase (A) and late-phase (B) fluorescein angiograms taken 2 weeks after laser photocoagulation of a choroidal neovascular focus in a patient with macular degeneration. There is ill-defined leakage (hyperfluorescence) along the temporal and superior aspect of the photocoagulation mark (arrow). Both early phase (C) and middle-phase (D) ICG angiograms demonstrate a small, well-defined focus of relative hyperfluorescence standing out in contrast at the margin of the hypofluorescent photocoagulation mark (arrow). Retreatment with laser photocoagulation directed at this hyperfluorescent spot alone resulted in rapid resolution of exudation.


Idiopathic Polypoidal Choroidal Vasculopathy

Polypoidal choroidal vasculopathy is a form of CNV with recurrent subretinal and sub-RPE serosangiousmacular detachments. The condition originally was thought to occur mainly in African-American women ages 40 to 80 years who are hypertensive or diabetic.61 However, recent studies have found this condition in Caucasian and Asian patients.62 IPCV demonstrates branching inner choroidal vessels with terminal aneurysmal-like dilatations. These lesions are most commonly found in the peripapillary region. However, isolated lesions can also be found in the macula or peripheral fundus.63IPCV appears as early, intense unilateral or multifocal hyperfluorescent “hot spots” on ICGA. The late phase of the ICGA shows a washout from the center of the polypoidal lesion with staining of the surrounding choroidal vasculature64–70 (Fig. 9) We have used ICGA to aid in the diagnosis of a case of presumed idiopathic polypoidal choroidal vasculopathy.64,65 The characteristic multiple, saccular aneurysmal-like dilatations in the choroid were readily apparent under associated blood and exudate (Fig. 12). Conventional thermal laser photocoagulation of these choroidal vascular anomalies can lead to resolution of the exudative manifestations, and the ICGA may serve to guide treatment analogous to localizing and directing laser treatment in selected cases of exudative macular degeneration.63 Successful treatment of IPCV lesions with photodynamic therapy has also been described.71

Fig. 9 A case of idiopathic polypoidal choroidal vasculopathy with active subretinal exudation and hemorrhage superotemporal to the optic nerve head. A. A relatively late-phase fluorescein angiogram photograph of the involved left eye shows multiple areas of ill-defined subretinal fluorescein leakage and some blocked fluorescence along the superotemporal arcade from subretinal hemorrhage. B. Early phase ICG angiogram reveals multiple, bright hyperfluorescent foci clustered along choroidal vessels. These foci are concentrated superotemporal to the optic nerve in the area of clinically apparent exudation.

Fig. 12 A deeply pigmented, dome-shaped choroidal melanoma in the nasal peripapillary area of the right eye. Early phase (A) and late-phase (B) ICG angiograms show the lesion to be relatively hypofluorescent with only punctate hyperfluorescent foci evident at the margins in the late phase. (Courtesy of Dr. J. Shields)

Retinal Angiomatous Proliferation

Retinal angiomatous proliferation (RAP) is a form of neovascular AMD in which the neovascularization appears to originate in the inner retinal layers then extends into the subretinal space, sometimes leading to a retinal-choroidal anastomosis. RAP lesions have a well-defined retinal–retinal anastomosis between the normal retinal vasculature and deep retinal vascular complex. With conventional fundus-camera based ICGA, RAP lesions show intense focal hyperfluorescence (hot spot) corresponding to the intraretinal neovascular focus. The lesion becomes more hyperfluorescent in the mid and late phases of the ICG as the dye leaks intraretinally.72 With SLO-based ICGA, both retinal feeding and draining vessels are often readily identified. RAP lesions are most easily detected when associated with a SPED with a background of ICGA hypofluorescence (Fig. 10) Identification of early stage RAP lesions may allow for successful treatment by a variety of approaches, such as conventional thermal laser treatment, photodynamic treatment (PDT), or surgical ablation of the anastomotic retinal vessels.73,74

Fig. 10 A. Early phase fluorescein angiogram shows a focal area of hyperfluorescence in the temporal macula. B. Late-phase fluorescein angiogram demonstrates diffuse, stippled hyperfluorescence consistent with occult neovascularization. C. SLO-based ICG demonstrates a “hot spot” with retinal vascular communication consistent with RAP.

Choroidal Feeder Vessel Treatment

Using SLO-based ICGA, investigators have been able to identify choroidal “feeder” vessels of AMD-related subfoveal choroidal neovascularization. The SLO allows for rapid image acquisition with rates of up to 20 frames per second. This allows for differentiating choroidal arteries from veins, which is not possible with fundus camera-based ICGA. Using SLO–ICGA and concentrating on the early choroidal filling phase, investigators have been able to identify choroidal vessels that directly feed CNV in selected cases (Fig. 11) Treatment of these “feeder” vessels with laser photocoagulation may or may not result in long-term involution of CNV.75–79 Further study with this treatment approach is needed.

Fig. 11 A. Pretreatment scanning laser ophthalmoscope high-speed indocyanine green angiography showing a well-delineated choroidal “feeder” (arrow) vessel supplying a large subfoveal neovascular complex. B. Posttreatment SLO-ICGA with laser photocoagulation applied to the feeder only (arrow) shows a lack of blood flow through the entire neovascular complex.


Studies have suggested that ICGA may have predictive value for the development of CNV in AMD. Different groups of investigators have found that eyes known to have dry AMD with only drusen and alterations in the retinal pigment epithelium and no leakage on fluorescein angiography occasionally harbor ICG hyperfluorescent plaques. The plaques were discovered incidentally in patients in whom the fellow eyes had active exudative signs. By following these patients over time, it was determined that the eyes that were clinically dry with ICG hyperfluorescent plaques were much more likely to develop exudative manifestations than dry AMD eyes without ICG abnormalities.80,81 Therefore, in people with dry AMD in one eye and a history of CNV in the fellow eye, the presence of incidental, abnormal ICG hyperfluorescence in the “dry” eye may be a predictive indicator of future exudative changes in that eye.44

Back to Top
ICGA has been used to study a variety of conditions that appear to affect or emanate from the choroid. The most well-described entity is central serous chorioretinopathy (CSCR).9,34,36,82 Both FA and ICGA show the typical hot spots at the level of the retinal pigment epithelium (RPE) in cases of CSCR. However, ICGA also reveals more widespread leakage from the surrounding choroid, additional small pigment epithelial detachments, and possible focal choroidal perfusion defects. In common to all reports is the phenomenon of more diffuse leakage of ICG dye under intact RPE, supporting the theory that in some fashion CSCR involves the choroidal vasculature. ICGA can be useful to distinguish between exudative AMD and atypical CSCR in older patients.36,83 Studies have also demonstrated the ability of ICGA to assist in the management of severe or chronic CSCR changes.84,85 ICGA-guided PDT treatment has been reported to aide in the resolution of exudative detachments in such cases.86
Back to Top
Theoretically, ICGA is more suitable than FA for imaging choroidal-based tumors and tumor-like lesions, given the limited leakage of ICG dye and the relatively good penetration of infrared light through pigment, such as melanin. Shields et al.35 performed a comprehensive analysis of ICGA patterns and choroidal tumors at Wills Eye Hospital. Pigmented choroidal nevi typically show relative hypofluorescence in all phases of the angiogram. The large, underlying normal choroidal vessels are often visible. Choroidal melanomas show variable patterns depending on their size, shape, and degree of pigmentation. In general, the intensity of fluorescence of the lesion is less than that of the surrounding normal choroid in all phases of the angiogram (Fig. 12). Late, speckled hyperfluorescence is occasionally encountered. Similar to FA, intralesional vessels are well visualized with the larger, less-pigmented tumors, particularly when the lesion is mushroom shaped. However, unlike the FA pattern of these larger melanomas, there is minimal apparent leakage from these vessels. Choroidal hemangiomas consistently exhibit abnormal, bright lacy hyperfluorescence very early in the angiographic sequence that is maximally intense by the middle phase (Fig. 13). Many show late isofluorescence or hypofluorescence, unlike what is typically seen with FA in which there is retention of dye and associated hyperfluorescence into the late stages. Last, ICGA of choroidal metastases usually demonstrates mostly hypofluorescence or isofluorescence through all phases of the angiogram (Fig. 14). Like melanomas, speckled hyperfluorescence may sometimes be seen along the border of the lesion. Unlike with melanomas or hemangiomas, the underlying normal choroidal pattern can occasionally be identified. Only limited data are available with other choroidal lesions at this time.

Fig. 13 ICGA of a well-circumscribed choroidal hemangioma located in the inferotemporal macular region. A. An early phase photograph taken 40 seconds after injection of dye shows irregular, lacy hyperfluorescence. B. A photograph taken 3 minutes into the angiogram shows more diffuse, bright lesional hyperfluorescence, which nearly completely fades by the late phase (C), with the lesion becoming mostly hypofluorescent. (Courtesy of Dr. C. Shields)

Fig. 14 ICGA of a dome-shaped choroidal metastasis located in the temporal macular area. Both early phase (A) and middle-phase (B) photographs show relative hypofluorescence without angiographically apparent lesional vascularity. (Courtesy of Dr. J. Shields)

As expected, the different patterns of fluorescence of these tumors appear to reflect their different choroidal vascular architecture with only minimal or no leakage of the ICG dye. Choroidal hemangiomas consistently exhibit a relatively unique fluorescence pattern, and ICGA may be a helpful test in differentiating these lesions from potentially simulating tumors, such as amelanotic choroidal melanomas and choroidal metastases.87 How ICGA compares with other diagnostic tests, such as FA and ultrasonography, in terms of sensitivity and specificity in this area is not known. Further investigation is needed to better assess its clinical utility in this area.

Back to Top
ICGA has been used to image a variety of other chorioretinal conditions. Although specific ICG angiography features or patterns have been identified in each of these general disease states, the ophthalmoscopic features alone are usually sufficient to make the diagnosis and to direct management.

In pathologic myopia, CNV is usually well demarcated and easily detectable with fluorescein angiography. Therefore, ICG angiography is rarely utilized in this setting. However, when hemorrhage is present, it is not unusual for fluorescein angiography to fail in differentiating between CNV and lacquer crack formation as possible sources of blood. The prognosis (and possibly management) can be very different between these sources, with the latter entity alone usually resulting in a much more favorable visual outcome. ICG angiography can be useful in this setting. Abnormal hyperfluorescence from CNV will often penetrate thin layers of blood, and lacquer cracks show as hypofluorescent rather than hyperfluorescent lines.88,89,90

There have been numerous reports of ICG angiographic findings with a variety of chorioretinal inflammatory diseases, such as multiple evanescent white-dot syndrome (MEWDS),38,91 acute posterior multifocal placoid pigment epitheliopathy (APMPPE),37,92,93 idiopathic enlarged blind spot syndrome,94 angioid streaks,95,96 Vogt-Koyanagi-Harada (VKH) syndrome,97 and multifocal choroiditis.98 In MEWDS, ICGA demonstrated multiple hypofluorescent lesions that obscured the underlying choroidal vessels.38 These spots were more apparent and widespread compared with either ophthalmoscopic or fluorescein angiographic findings. ICGA-based choroidal blood flow analysis in two patients with APMPPE revealed a significant delay in choroidal filling and large areas of choroidal vascular nonperfusion in the acute stage of the disease.37 In both conditions, the ICGA abnormalities completely disappeared as the conditions clinically resolved. Evaluation of the idiopathic enlarged blind spot syndrome with ICGA has revealed choroidal involvement with hypofluorescence involving the peripapillary area and the entire posterior pole.94 ICGA for multifocal choroiditis showed multiple hypofluorescent spots in the posterior pole. This may be useful in distinguishing CNV from acute inflammatory foci in the macula.98

Kohno et al.99 have also demonstrated via ICGA an underlying choroidopathy following blunt trauma with lack of visual recovery. ICGA has also been used to confirm the diagnosis of a vortex vein varix in a patient suspected of having a choroidal tumor.100 The technique was able to demonstrate dynamic pooling of ICG dye in the abnormal vortex vein ampulla as the field of gaze was shifted.

These findings are more often of academic interest in helping elucidate disease pathophysiology and determining relationships among these disease entities. At this time, ICGA, in general, has limited routine clinical utility in these conditions.

Back to Top
Although more often than not abnormal ICG hyperfluorescence appears to represent actively proliferating CNV that is directly resulting in clinically evident exudative changes, the angiogram must always be interpreted in the context of recent fluorescein angiographic and ophthalmoscopic findings. This is particularly so when laser treatment or retreatment is being considered. Artifactual ICG hyperfluorescence can be seen at the choroidal vessels crossing and can be misinterpreted as a hot spot, although this form of hyperfluorescence would be expected to fade rather than to increase in intensity in the late phases. Piccolino et al.101 have demonstrated preinjection fluorescence (either pseudofluorescence or autofluorescence) that simulate vascular filling from lesions, such as old, gray subretinal blood, lipofuscin-like deposits, pigmented CNV, and chronic serous retinal detachments. Furthermore, Regillo et al.60 detected abnormal hyperfluorescence at the edge of a laser treatment site simulating persistent CNV that spontaneously disappeared a few weeks later. Additional laser treatment was withheld because the clinical appearance and fluorescein angiogram suggested that treatment had been successful (without persistent CNV) at all follow-up points. This “temporary” abnormal hyperfluorescence at the edge of a recent laser treatment site may represent localized choroidal vasculitis, regressing remnants of CNV, or an unexplained form of hyperfluorescent artifact.

In general, laser treatment directed at abnormal ICG lesions should be performed only when there is a reasonable degree of certainty that the lesion identified is the source of the clinically apparent exudative manifestations. ICG abnormalities far outside the area of exudative signs or in the absence of exudative signs should be closely observed.44

Back to Top

1. Destro M, Puliafito CA: Indocyanine green videoangiography of choroidal neovascularization. Ophthalmology 96:846–853, 1989

2. Scheider A, Schroedel C: High resolution indocyanine green angiography with a scanning laser ophthalmoscope. Am J Ophthalmol 108:458–459, 1989

3. Guyer DR, Puliafito CA, Monés JM, et al: Digital indocyanine-green angiography in chorioretinal disorders. Ophthalmology 99:287–291, 1992

4. Yannuzzi LA, Slakter JS, Sorenson JA, et al: Digital indocyanine green videoangiography and choroidal neovascularization. Retina 12:191–223, 1992

5. Kogure K, David NJ, Yamanouchi U, et al: Infrared absorption angiography of the fundus circulation. Arch Ophthalmol 83:209–214, 1970

6. Hochheimer BF: Angiography of the retina with indocyanine green. Arch Ophthalmol 86:564–565, 1971

7. Flower RW, Hochheimer BF: A clinical technique and apparatus for simultaneous angiography of the separate retinal and choroidal circulations. Invest Ophthalmol 12:248–261, 1973

8. Bischoff PM, Flower RW: Ten years experience with choroidal angiography using indocyanine green dye: A new routine examination or an epilogue? Doc Ophthalmol 60:235–291, 1985

9. Hayashi K, Hasegawa Y, Tokoro T: Indocyanine green angiography of central serous chorioretinopathy. Int Ophthalmol 9:37–41, 1986

10. Hayashi K, Hasegawa Y, Tazawa T, et al: Clinical application of indocyanine green angiography to choroidal neovascularization. Jpn J Ophthalmol 33(1):57–65, 1989

11. Regillo CD, Benson WE, Maguire JI, et al: Indocyanine green angiography and occult choroidal neovascularization. Ophthalmology 101:280–288, 1994

12. Scheider A, Kaboth A, Neuhauser L: Detection of subretinal neovascular membranes with indocyanine green and an infrared scanning laser ophthalmoscope. Am J Ophthalmol 113:45–51, 1992

13. Kuck H, Inhoffen W, Schneider U, et al: Diagnosis of occult subretinal neovascularization in age-related macular degeneration by infrared scanning laser videoangiography. Retina 13:36–39, 1993

14. Fox IJ, Wood EH: Indocyanine green: Physical and physiologic properties. Mayo Clin Proc 35:732–744, 1960

15. Cherrick GR, Stein SW, Leevy CM, Davidson CS: Indocyanine green: Observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest 39:592–600, 1960

16. Paumgartner G: The handling of indocyanine green by the liver. Schweiz Med Wochenschr 105(17 suppl):1–30, 1975

17. Flower RW, Hochheimer BF: Indocyanine green dye fluorescence and infrared absorption choroidal angiography performed simultaneously with fluorescein angiography. Johns Hopkins Med J 138:33–42, 1976

18. Benson RC, Kues HA: Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol 23:159–163, 1978

19. Baker KJ: Binding of sulfobromophthalein (BSP) sodium and indocyanine green by plasma alpha 1 lipoproteins. Proc Soc Exp Biol Med 122(4):957–963, 1966

20. Brown N, Strong R: Infrared fundus angiography. Br J Ophthalmol 57(10):797–802, 1973

21. Rapaport E, Ketterer SG, Wiegand BD: Hepatic clearance of indocyanine green. Clin Res 7:289–290, 1959

22. Probst P, Paumgartner G, Caucig H, et al: Studies on clearance and placental transfer of indocyanine green during labor. Clin Chim Acta 29:157–160, 1970

23. Benya R, Quintana J, Brundage B: Adverse reactions to indocyanine green: A case report and a review of the literature. Cathet Cardiovasc Diagn 17:231–233, 1989

24. Hope-Ross M, Yannuzzi LA, Gragoudas ES, et al: Adverse reactions to indocyanine green. Ophthalmology 101:529–533, 1994

25. Olsen TW, Lim JI, Capone A, et al: Anaphylactic shock following indocyanine green angiography. Arch Ophthalmol 114:97, 1996

26. Wolf S, Arend O, Schulte K, et al: Severe anaphylactic reaction after indocyanine green fluorescein angiography. Am J Ophthalmol 114:638–639, 1992

27. Yannuzzi LA, Rohrer KT, Tindel LJ, et al: Fluorescein angiography complication survey. Ophthalmology 93:611–617, 1986

28. Fineman MS, Maguire JI, Fineman SW, et al: Safety of indocyanine green angiography during pregnancy: A survey of the retina, macula, and vitreous societies. Arch Ophthalmol 119(3): 352–355, 2001

29. Maberley DA, Cruess AF: Indocyanine green angiography: An evaluation of image enhancement for the identification of occult choroidal neovascular membranes. Retina 19:37–44, 1999

30. Flower RW, Csaky KG, Murphy RP: Disparity between fundus camera and scanning laser ophthalmoscope indocyanine green imaging of retinal pigment epithelium detachments. Retina 18:260–268, 1998

31. Bratsch D, Weinreb RN, Zinser G, et al: Confocal scanning infrared laser ophthalmoscopy for indocyanine green angiography. Am J Ophthalmol 120:642–651, 1995

32. Gelisken F, Inhoffen W, Schneider U, et al: Indocyanine green videoangiography of occult choroidal neovascularization: A comparison of scanning laser ophthalmoscope with high-resolution digital fundus camera. Retina 18:37–43, 1998

33. Brucker AJ, Brant A, Nyberg W: Landmark injection for localization of choroidal lesions using indocyanine green angiography. Retina 13:169–171, 1993

34. Scheider A, Nasemann JE, Lund OE: Fluorescein and indocyanine green angiographies of central serous choroidopathy by scanning laser ophthalmoscope. Am J Ophthalmol 115:50–56, 1993

35. Shields CL, Shields JA, DePotter P: Patterns of indocyanine green videoangiography of choroidal tumours. Br J Ophthalmol 79(3):237–245, 1995

36. Guyer DR, Yannuzzi LA, Slakter JS, et al: Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol 112:1057–1062, 1994

37. Dhaliwal RS, Maguire AM, Flower RW, et al: Acute posterior multifocal placoid pigment epitheliopathy: An indocyanine green angiographic study. Retina 13:317–325, 1993

38. Ie D, Glaser BM, Murphy RP, et al: Indocyanine green angiography in multiple evanescent white-dot syndrome. Am J Ophthalmol 117:7–12, 1994

39. Prunte C, Niesel P: Quantification of choroidal blood-flow parameters using indocyanine green video-fluorescence angiography and statistical picture analysis. Graefes Arch Clin Exp Ophthalmol 226:55–58, 1988

40. Klein GJ, Baumgartner RH, Flower RW: An image processing approach to characterizing choroidal blood flow. Invest Ophthalmol Vis Sci 31:629–637, 1990

41. Flower RW, Klein GJ: Pulsatile flow in the choroidal circulation: A preliminary investigation. Eye 4:310–318, 1990

42. Flower RW: Extraction of choriocapillaris hemodynamic data from ICG fluorescence angiograms. Invest Ophthalmol Vis Sci 18:2720–2729, 1993

43. MacCumber MW, Flower RW, Langham ME: Ischemic hypertensive choroidopathy: Fluorescein angiography, indocyanine green videoangiography, and measurement of pulsatile flow. Arch Ophthalmol 111:704–705, 1993

44. Regillo CD: The present role of indocyanine green angiography in ophthalmology. Curr Opin Ophthalmol 10:189–196, 1999

45. Ross RD, Barofsky JM, Cohen G, et al: Presumed macular choroidal watershed vascular filling, choroidal neovascularization, and systemic vascular disease in patients with age-related macular degeneration. Am J Ophthalmol 125:71–80, 1998

46. Goldberg MF, Dhaliwal RS, Olk RJ: Indocyanine green angiography patterns of zones of relative decreased choroidal blood flow in patients with exudative age-related macular degeneration. Ophthalmic Surg Lasers 29:385–390, 1998

47. Arnold JJ, Quaranta M, Soubrane G: Indocyanine green angiography of drusen. Am J Ophthalmol 124:344–356, 1997

48. Gass JDM: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th ed, vol 1. St. Louis: CV Mosby, 1997:70–105

49. Lim JI, Sternberg P, Capone A, et al: Selective use of indocyanine green angiography for occult choroidal neovascularization. Am J Ophthalmol 120:75–82, 1995

50. Guyer DR, Yannuzzi LA, Slakter JS, et al: Classification of choroidal neovascularization by digital indocyanine green videoangiography. Ophthalmology 103:2054–2060, 1996

51. Reichel E, Duker JS, Puliafito CA: Indocyanine green angiography and choroidal neovascularization obscured by hemorrhage. Ophthalmology 102:1871–1876, 1995

52. Guyer DR, Yannuzzi LA, Slakter JS, et al: Digital indocyanine-green videoangiography of occult choroidal neovascularization. Ophthalmology 101:1727–1737, 1994

53. Sorenson JA, Yannuzzi LA, Slakter JS, et al: A pilot study of digital indocyanine green videoangiography for recurrent occult choroidal neovascularization in age-related macular degeneration. Arch Ophthalmol 112:473, 1994

54. Guyer DR, Yannuzzi LA, Ladas I, et al: Indocyanine green-guided laser photocoagulation of focal spots at the edge of plaques of choroidal neovascularization. Arch Ophthalmol 114:693–697, 1996

55. Bressler NM, Frost LA, Bressler SB, et al: Natural course of poorly defined choroidal neovascularization associated with macular degeneration. Arch Ophthalmol 106:1537–1542, 1988

56. Soubrane G, Coscas G, Français C, et al: Occult subretinal new vessels in age-related macular degeneration: Natural history and early laser treatment. Ophthalmology 97:649–657, 1990

57. Baumal CR, Reichel E, Duker JS, et al: Indocyanine green hyperfluorescence associated with serous retinal pigment epithelial detachment in age-related macular degeneration. Ophthalmology 104:761–769, 1997

58. Lim JI, Aaberg TM, Capone A, et al: Indocyanine green angiography-guided photocoagulation of choroidal neovascularization associated with retinal pigment epithelial detachment. Am J Ophthalmol 123:524–532, 1997

59. Chang TS, Freund KB, De La Cruz Z, et al: Clinicopathologic correlation of choroidal neovascularization demonstrated by indocyanine green angiography in a patient with retention of good visions for almost four years. Retina 14:114–124, 1994

60. Regillo CD, Blade KA, Custis PH, O'Connell SR: Evaluating persistent and recurrent choroidal neovascularization: The role of indocyanine green angiography. Ophthalmology 105:1821–1826, 1998

61. Phillips WB, Regillo CD, Maguire JI: Indocyanine green angiography of idiopathic polypoidal choroidal vasculopathy. Ophthalmic Surg Lasers 27:467–470, 1996

62. Ahuja RM, Stanga PE, Vingerling JR, et al: Polypoidal choroidal vasculopathy in exudative and haemorrhagic pigment epithelial detachements. Br J Ophthalmol 84:479–484, 2000

63. Moorthy RS, Lyon AT, Rabb MF, et al: Idiopathic polypoidal choroidal vasculopathy of the macula. Ophthalmology 105:1380–1385, 1998

64. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B: Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 10:1–8, 1990

65. Kleiner RC, Brucker AJ, Johnston RL: The posterior uveal bleeding syndrome. Retina 10:9–17, 1990

66. Ciardella AP, Donsoff IM, Yannuzzi LA: Polypoidal choroidal vasculopathy. Ophthalmol Clin N Am 15:537–554, 2002

67. Yanuzzi LA, Ciardella AP, Spaide RF, et al: The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 115:478–485, 1999

68. Spaide RF, Yanuzzi LA, Slakter JS, et al: Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina 15:100–110, 1995

69. Labaut BA, Aisenbrey S, van den Broecke C, et al: Polypoidal choroidal vasculopathy pattern in age-related macular degeneration. Retina 20:650–654, 2000

70. Yanuzzi LA, Wong DW, Sforzoline BS, et al: Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol 17:1503–1510, 1999

71. Spaide RF, Donsoff I, Lam DL, et al: Treatment of polypoidal choroidal vasculopathy with photodynamic therapy. Retina 22:529–535, 2002

72. Yannuzzi LA, Negrão S, Iida T, et al: Retinal angiomatous proliferation in age-related macular degeneration. Retina 21:416–434, 2001

73. Slatker JS, Yanuzzi LA, Scheider U, et al: Retinal choroidal anastomosis and occult choroidal neovascularization. Ophthalmol 107:742–753, 2000

74. Borrillo JL, Sivalingam A, Martidis A, Federman JL: Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol 12:558–561, 2003

75. Flower RW: Optimizing treatment of choroidal neovascularization feeder vessels associated with age-related macular degeneration. Am J Ophthalmol 134:228–239, 2002

76. Melberg NS, Thomas MA: Successful feeder vessel laser treatment of recurrent neovascularization following subfoveal surgery. Arch Ophthalmol 114:224–226, 1996

77. Shiraga F, Ojima Y, Matsuo T, et al: Feeder vessel photocoagulation of subfoveal choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology 105:662–669, 1998

78. Staurenghi G, Orzalesi N, La Capria A, et al: Laser treatment of feeder vessels in subfoveal choroidal neovascular membranes: A revisitation using dynamic indocyanine green angiography. Ophthalmology 105:2297–2305, 1998

79. Desatnik H, Treister G, Alhalel A, et al: ICGA-guided laser photocoagulation of feeder vessels of choroidal neovascular membranes in age-related macular degeneration. Retina 20:143–150, 2000

80. Schneider U, Gelisken F, Inhoffen W, et al: Indocyanine green angiographic findings in fellow eyes of patients with unilateral occult neovascular age-related macular degeneration. Int Ophthalmol 21:79–85, 1997

81. Hanutsaha P, Guyer D, Yannuzzi LA, et al: Indocyanine green videoangiography of drusen as a possible predictive indicator of exudative maculopathy. Ophthalmology 105:1632–1636, 1998

82. Piccolino FC, Borgia L: Central serous chorioretinopathy and indocyanine green angiography. Retina 14:231–242, 1994

83. Spaide RF, Hall L, Haas A, et al: Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina 16:203–213, 1996

84. Uyama M, Matsunaga H, Matsubara T, et al: Indocyanine green angiography and pathophysiology of multifocal posterior pigment epitheliopathy. Retina 19:12–21, 1999

85. Shiraki K, Moriwaki M, Matsumoto M, et al: Long-term follow-up of severe central serous chorioretinopathy using indocyanine green angiography. Int Ophthalmol 21:245–253, 1998

86. Yannuzzi LA, Slakter JS, Gross NE: Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy. Retina 23:288–298, 2003

87. Piccolino FC, Borgia L, Zinicola E: Indocyanine green angiography of circumscribed choroidal hemangiomas. Retina 16:19–28, 1996

88. Quaranta M, Arnold J, Coscas G, et al: Indocyanine green angiographic features of pathologic myopia. Am J Ophthalmol 122:663–671, 1996

89. Ohno-Matsui K, Morishima N, Ito M, et al: Indocyanine green angiographic findings of lacquer cracks in pathologic myopia. Jpn J Ophthalmol 42:293–299, 1998

90. Ohno-Matsui K, Ito M, Tokoro T: Subretinal bleeding without choroidal neovascularization in pathologic myopia: A sign of new lacquer crack formation. Retina 16:196–202, 1996

91. Obana A, Kusumi M, Miki T: Indocyanine green angiographic aspects of multiple evanescent white dot syndrome. Retina 16:97–104, 1996

92. Howe LJ, Woon H, Graham EM, et al: Choroidal hypoperfusion in acute posterior multifocal placoid pigment epitheliopathy: An indocyanine green angiography study. Ophthalmology 102:790–798, 1995

93. Park D, Schatz H, McDonald R, Johnson RN: Indocyanine green angiography of acute multifocal posterior placoid pigment epitheliopathy. Ophthalmology 102:1877–1883, 1995

94. Pece A, Sadun F, Trabucchi G, et al: Indocyanine green angiography in enlarged blind spot syndrome. Am J Ophthalmol 126:604–607, 1998

95. Pece A, Avanza P, Introini U, et al: Indocyanine green angiography in angioid streaks. Acta Ophthalmol Scand 75:261–265, 1997

96. Quaranta M, Cohen S, Krott R, et al: Indocyanine green videoangiography of angioid streaks. Am J Ophthalmol 119:136–142, 1995

97. Oshima Y, Harino S, Hara Y, et al: Indocyanine green angiographic findings in Vogt-Koyanagi-Harada disease. Am J Ophthalmol 122:58–66, 1996

98. Slakter JS, Giovannini A, Yannuzzi LA, et al: Indocyanine green angiography of multifocal choroiditis. Ophthalmology 104:1813–1819, 1997

99. Kohno T, Miki T, Hayashi K: Choroidopathy after blunt trauma to the eye: A fluorescein and indocyanine green angiographic study. Am J Ophthalmol 126:248–260, 1998

100. Singh AD, De Potter P, Shields CL, et al: Indocyanine green angiography and ultrasonography of a varix of vortex vein. Arch Ophthalmol 111:1283–1284, 1993

101. Piccolino FC, Borgia L, Zinicola E: Pre-injection fluorescence in indocyanine green angiography. Ophthalmology 103:1837–1845, 1996

Back to Top