Changes of Choroidal Perfusion in Indocyanine Green Angiography After Photodynamic Therapy for Choroidal Neovascularization

Lee Hwa; Woo Kim Seong; Huh Kuhl

doi:10.3341/jkos.2009.50.1.69

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Hwa, Seong, and Kuhl: Changes of Choroidal Perfusion in Indocyanine Green Angiography After Photodynamic Therapy for Choroidal Neovascularization

Original Article

J Korean Ophthalmol Soc 2009;50(1):69-77.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.69

Changes of Choroidal Perfusion in Indocyanine Green Angiography After Photodynamic Therapy for Choroidal Neovascularization

Lee Hwa, M.D, Woo Kim Seong, M.D, Huh Kuhl, M.D

Department of Ophthalmology, Korea University College of Medicine, Seoul, Koreaa

Address reprint requests to Kuhl Huh, MD Department of Ophthalmology, Guro Hospital, Korea University College of Medicine #97 Guro-dong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: dumky@unitel.co.kr

Received 21 October 2008 Accepted 14 January 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the changes of choroidal perfusion after photodynamic therapy (PDT) documented by indocyanine green angiography (ICGA) and in pretreatment and posttreatment variables in patients with choroidal neovascularization (CNV) of age-related macular degeneration (AMD) and myopia (M).

Methods

Eight eyes (seven patients) with CNV in M (Group 1) and 30 eyes (29 patients) with CNV in AMD (Group 2) were included among 38 eyes (36 patients) that underwent PDT. ICGA, fluorescein angiography, optical coherence tomography (OCT) for central foveal thickness were conducted. Changes of choroidal perfusion were graded on a five point scales based on the degree of choridal hypoperfusion in the early and late phases of ICGA.

Results

Choriocapillary hypoperfusion was seen in 10 eyes among 30 eyes (33.3%) in group 2, but not in group 1 and the difference was statistically significant (p=0.002). However there is a limitation in confirming choroidal hypoperfusion owing to the thinning of both choriocapillaris and the RPE-Bruch's membrane complex in myopic CNV. In patients with CNV in AMD (Group 2), presence of choroidal hypoperfusion before PDT was accociated with the progression of hypoperfusion after PDT (p=0.001).

Conclusions

In CNV in AMD, presence of choroidal hypoperfusion before treatment seems to play a role in progression of hypoperfusion after treatment.

Keywords: Age-related macular degeneration, Choroidal hypoperfusion, Indocyanine green angiography, Photodynamic therapy

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Figure 1.

(A) Fundus photograph shows choroidal neovascularization and myopic conus. (B) Blocked fluorescence on fluorescein angiograph (FA) before photodynamic therapy (PDT) due to hemorrhage on choroidal neovascular component. (C) Choroidal neovascularization was identified on early Indocyanine green angiography (ICGA) before PDT. (D) Before PDT, there was no remarkable hypofluorescence on late ICGA. (E),(F) There was no change on fundus photograph and photograph of FA 3 months after PDT. (G) There was no significant change on early ICGA 3 months after PDT. (H) There was no significant decrease of fluorescence on late ICGA 3 months after PDT.

Figure 2.

(A) Fundus photograph shows classic choroidal neovascularization in age-related macular degeneration. (B) large classic choroidal neovascular component shows early hyperfluorescence on FA before PDT. (C) Choroidal neovascularization was identified on early ICGA before PDT. (D) Before PDT, there was no remarkable hypofluorescence on late ICGA. (E) Fundus photograph 3 months after PDT. (F) Early hyperfluorescence disappeared on FA 3 months after PDT. (G) Early ICGA 3 months after PDT shows evident hypofluorescence. (H) Intensive hypofluorescence characterized by absence of choroidal perfusion markedly increased in size and intensity on late ICGA 3 months after PDT.

Table 1.

Patient Characteristics Mean± standard deviation

	Group 1 (Myopic CNV^∗)	Group 2 (AMD^†)	p value
Number of eyes	8	30	-
Mean Age (year)	41.3±16.3	65.5±8.5	0.001
Male/Female	4/4	18/12	0.849
OD^‡/OS^§	4/4	12/18	0.849

Mann-Whitney U t-test;

^∗ CNV=Choroidal neovascularization;

^† AMD=age-related macular degeneration;

^‡ OD=right eye;

^§ OS=left eye.

Table 2.

Visual acuity (log MAR) & Central macular thickness (µm) measured by OCT^*

	Group 1 (Myopic CNV^†)	Group 2 (AMD^‡)	p value
Number of PDT^§ (times)	1.63	2.00	0.534
Pre Visual acuity (log MAR)	0.71±0.41	0.77±0.43	0.750
Post Visual acuity (log MAR)	0.87±0.60	0.70±0.43	0.263
Pre Macular thickness on OCT^∗ (µm)	234.8±70.7	241.3±77.7	0.483
Post Macular thickness on OCT^∗ (µm)	233.1±74.3	193.1±61.8	0.124
Spot size (µm)	3268.3±1330.8	5080.9±1860.6	0.271

Mean± standard deviation; Mann-Whitney U t-test;

^∗ OCT=optical coherence tomography

^† CNV=Choroidal neovascularization

^‡ AMD=age-related macular degeneration

^§ PDT=photodynamic therapy.

Table 3.

Sub-group Characteristics in AMD^∗ Mean± standard deviation

	Group A (No change)	Group B (Progression of hypoperfusion)	p value
Number of eyes	20	10	-
Mean Age (years)	66.2±8.2	64.5±8.5	0.715
Male/Female	10/10	8/2	0.581
OD^†/OS^‡	8/12	4/6	0.263

Mann-Whitney U t-test;

^∗ AMD=age-related macular degeneration

^† OD=right eye

^‡ OS=left eye.

Table 4.

Distribution of No. of PDT∗ in AMD^†

Subgroup Number of PDT^∗	Group A (No change)	Group B (Progression of hypoperfusion)	Total
1	11 (55.0%)	5 (50.0%)	16
2	8 (40.0%)	2 (20.0%)	10
3	0 (0%)	3 (30.0%)	3
4	1 (5.0%)	0 (0%)	1

^∗ PDT=photodynamic therapy

^† AMD=age-related macular degeneration.

Table 5.

Visual acuity (log MAR) & Central macular thickness (µm) measured by OCT^* in AMD^† Mean± standard deviation

	Group A (No change)	Group B (Progression of hypoperfusion)	p value
Pre Visual acuity (log MAR)	0.73±0.40	0.83±0.51	0.561
Post Visual acuity (log MAR)	0.71±0.46	0.68±0.40	0.579
Pre Macular thickness on OCT^* (µm)	219.4±52.2	256.1±98.6	0.814
Post Macular thickness on OCT^∗ (µm)	186.1±46.3	204.8±81.7	0.593

Mann-Whitney U t-test;

^∗ OCT=optical coherence tomography

^† AMD=age-related macular degeneration

Table 6.

Changes in choroidal perfusion Pre-PDT^* in AMD^† CNV^‡

	Group A (No change)	Group B (Progression of hypoperfusion)	p value
Pre-PDT^∗ normal perfusion (eyes)	19	3	0.001
Pre-PDT^∗ Hypoperfusion (eyes)	1	7	0.001

Fisher’s Exact test; cularization

^∗ PDT=photodynamic therapy

^† AMD=Age-related macular degeneration;

^‡ CNV=Choroidal neovascularization

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