The role of indocyanine green angiography in evaluating recurrent choroidal neovascularization

Purpose. To evaluate the clinical utility of routinely using indocyanine angiography (ICGA) as an adjunct to fluorescein angiography (FA) in detecting recurrent choroidal neovascularization (CNV). Methods. In a prospective, consecutive fashion, all patients with age-related macular degeneration (AMD) that had previously treated CNV were studied with both FA and ICGA at the first post-treatment evaluation and all subsequent follow-up visits when recurrent CNV was suspected clinically. The quantitative (presence or absence) and qualitative (well- or ill-defined) aspects of CNV detection were then analyzed. Results. Forty-nine FAICGA studies were performed on 20 eyes of 19 patients. FA showed well-defined CNV in 10 of the 49 (20%) studies. Of these 10 studies, ICGA revealed well-defined CNV in 7 (70%), ill-defined CNV in 1 (10%), and no CNV in 2 (20%). In 17 of 49 (35%) studies, FA showed ill-defined CNV. In these 17 studies, ICGA showed welldefined CNV in 8 (47%), ill-defined CNV in 4 (24%), and no abnormalities in 5 (29%). In remaining 22 (45%) studies, the FA was negative for CNV persistence or recurrence, and, of these, ICGA was similarly negative in 19 (86%), but showed well-defined and ill-defined CNV in 1 and 2 studies, respectively. Conclusions. In the post-treatment setting, ICGA appears to be a valuable adjunct to FA in terms of belter delineating CNV only when the FA shows ill-defined CNV. However, when the FA shows either well-defined CNV or no CNV, ICGA offers little or no additional useful information. Therefore, the routine use of ICGA with FA to detect AMD-related CNV in eyes after laser treatment is not justified.