INDOCYANINE-GREEN VIDEOANGIOGRAPHY OF DRUSEN AS A POSSIBLE PREDICTIVEINDICATOR OF EXUDATIVE MACULOPATHY

Objective: Recent studies have shown that indocyanine-green videoangio graphy (ICG-V) is useful to image occult choroidal neovascularization. The authors studied the ICG-V findings in fellow drusen eyes of patie nts with unilateral exudative age-related macular degeneration (AMD). The authors also studied the occurrence of exudative changes to determ ine whether ICG-V is useful in predicting future exudative changes in these eyes with only drusen. Design: Cohort study. Participants: The a uthors studied 432 consecutive patients diagnosed with unilateral exud ative AMD in whom the fellow eye had only drusen by clinical fundus ex amination and fluorescein angiography. All of these eyes had ICG-V per formed. Follow-up data were obtained in all eyes with abnormal indocya nine-green (ICG) angiograms and randomly sampled ICG angiograms of nor mal eyes. Main Outcome Measures: The initial ICG findings were classif ied as showing normal or abnormal hyperfluorescence. Abnormal hyperflu orescence eyes were subdivided into focal spots (focal areas of hyperf luorescence < 1 disc area in size) and plaques (areas of hyperfluoresc ence > 1 disc area). The development of exudative changes in eyes with normal and abnormal hyperfluorescence was compared. Results: Of the 4 32 fellow eyes, 386 (89%) eyes with drusen had a normal ICG-V study, w hereas 46 (10 focal spots and 36 plaques) (11%) eyes had an abnormal I CG-V. Exudative changes occurred in 6 (10%) of 58 normal ICG eyes and 9 (24%) of 38 eyes with abnormal ICG findings during a mean follow-up period of 21.7 months. The difference between drusen eyes with normal ICG angiograms and those with plaques on ICG-V regarding future exudat ive changes (10% vs. 27%, respectively) was statistically significant (P = 0.038). Conclusions: Abnormal ICG findings were found in 11% of e yes with clinically and fluorescein angiographically nonsuspicious dru sen. The subgroup of patients with plaques on ICG-V had a higher chanc e of having exudative changes develop. Indocyanine-green videoangiogra phy may be a predictive indicator of future exudative changes in eyes with drusen. A much larger prospective study seems justified.