INDOCYANINE GREEN VIDEOANGIOGRAPHIC FINDINGS IN DETACHMENT OF THE RETINAL-PIGMENT EPITHELIUM

Background: Several forms of retinal pigment epithelial detachment hav e been reported. The authors used indocyanine green (ICG) videoangiogr aphy, which is useful to study the choroidal vasculature and Bruch mem brane, to study pigment epithelial detachments. Methods: Ninety-eight pigment epithelial detachments in 75 eyes were classified based on the appearance of choroidal neovascular membranes or late phase findings of ICG videoangiography done at the initial examination. The authors a lso followed the evolution of 51 such detachments not associated with choroidal neovascularization (CNV). Results: Sixty-four pigment epithe lial detachments without CNV were divided into five groups. Among eyes with pigment epithelial detachments that showed intense hyperfluoresc ence, all except one of the patients had both eyes involved and had se veral pigment epithetial detachments, sometimes with exudative retinal detachments. Weak hyperfluorescence was observed more often in younge r patients. During follow-up of eyes with pigment epithelial detachmen ts that showed irregular hypofluorescence, a neovascular membrane deve loped in one eye, microrips developed in four eyes and retinochoroidal folds in one eye. Most eyes that showed irregular hyperfluorescence d eveloped atrophy of the retinal pigment epithelium. In 34 pigment epit helial detachments with CNV, either irregular hypofluorescence or abse nce of fluorescence was observed in areas that corresponded to the pig ment epithelial detachment. Conclusion: The intense hyperfluorescence is thought to be due to the accumulation of protein-rich fluid within the pigment epithelial detachment. Most pigment epithelial detachments that showed weak fluorescence probably represent variants of central serous choroidopathy. Pigment epithelial detachments that showed irreg ular hypofluorescence or hyperfluorescence were associated with age-re lated macular degeneration, and the former was correlated closely with CNV. Close follow-up therefore is recommended for eyes with pigment e pithelial detachments that show irregular hypofluorescence.