Indocyanine green angiography of retinal pigment epithelial tears

Purpose: To investigate the fluorescein and indocyanine green (ICG) feature s before and after retinal pigment epithelial tear. Methods: Fluorescein and ICG videoangiography were performed in 30 patients affected by age-related macular degeneration either complicated by tear of the retinal pigment epithelium (25 eyes) or by pigment epithelial detachme nt with pretear characteristics (5 eyes), Results: At the pretear stage fluorescein angiography (FA) showed in all ca ses signs of occult CNV associated with delayed, slow and uneven filling of the pigment epithelium detachment. In 2 eyes the ICG filling of the retina l pigment epithelial detachment was seen. Progression to the tear stage was seen in 4 eyes where a CNV was evident on ICG angiography; in two eyes wit hin one month after laser photocoagulation, At the tear stage FA showed an area of marked hyperfluorescence with well defined margins. Adjacent to the exposed area the torn RPE was markedly hypofluorescent during all angiogra phic phases. The bare choroid was always hypo or normofluorescent on ICG an giography, The torn retinal pigment epithelium showed moderate hypofluoresc ence, The exact seat and extension of CNVs could be visualized in 20 cases (67%; 95% C.I., 50-84%) with ICG angiography vs 6 cases (20%; 95% C.I., 6-3 4%) with FA (p<0.001). Conclusions: ICG angiography did not add anything substantial to the analys is of frank tears. The most useful application of ICG angiography in this d isease is the visualization of the seat and extension of the associated CNV . In fact, it is well known that laser treatment of a pigment epithelial de tachment at the pretear stage may facilitate the development of a tear of t he RPE.