Simultaneous Indocyanine Green and Fluorescein ...

Simultaneous Indocyanine Green and Fluorescein Angiography

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Background  Fluorescein and indocyanine green (ICG) angiography are both indispensable tools in diagnosing and treating various retinal diseases. In certain clinical instances, it becomes essential to perform both imaging tests for an accurate diagnosis or treatment; however, this often results in prolonged procedures necessitating multiple injections.

Methods  We developed a compact digital confocal scanning laser ophthalmoscope capable of conducting true simultaneous fluorescein and ICG angiography. Our clinical experience encompasses 169 angiograms performed in 117 patients.

Results  The merging of the dyes and single-injection administration posed no unexpected adverse effects. The full examination, including fundus photography, fluorescein angiography, and ICG angiography, could be efficiently completed within 45 minutes. This method enables the assessment of differences in fluorescein patterns by comparing identically timed frames, determining optimal scenarios for either ICG or fluorescein angiography in the visualization of retinal and subretinal structures. Moreover, the confocal optical sections in the depth (z) dimension facilitated the observation in various planes, allowing the overlay or side-by-side comparison of ICG and fluorescein images using a linked cursor. Digital transmission of these images further enriched the study.

Conclusions  Rapid, safe, and convenient execution of simultaneous ICG and fluorescein angiography is possible. This advancement grants clinicians the ability to critically assess the relative benefits and limitations of both imaging types.

Fluorescein angiography provides vital diagnostic insights into various retinal diseases, enabling visualization of the retinal and choroidal vascular system. Furthermore, indocyanine green (ICG) angiography has emerged as a valuable adjunct, particularly in cases where fluorescein's imaging capabilities are insufficient. While ICG encompasses larger molecules that fluoresce in the infrared spectrum, its integration has notably enhanced clinical assessments, especially concerning subretinal neovascularization.

The integration of the scanning laser ophthalmoscope has brought significant advancements in angiography. This apparatus employs an excitation light scanning method that affords intense excitation while maintaining safe illumination levels, allowing imaging at higher frame rates than conventional digital imaging systems. Consequently, it enhances the visibility of vascular details during the transient phases of angiography while also facilitating stereoscopic imaging.

This study reports on the use of a confocal scanning laser ophthalmoscope to achieve simultaneous imaging with ICG and fluorescein after a solitary intravenous injection. By utilizing this state-of-the-art instrument, we demonstrate that quality images can be obtained while minimizing patient inconvenience. Importantly, this approach alleviates the need for sequential angiography that often leads to discrepancies in observations due to the differences in timings and image quality. To further discuss your requirements for Indocyanine Green Angiography, we invite you to reach out to our experienced sales team for personalized assistance.

Results and Clinical Application

Out of the 169 angiograms conducted, none elicited serious adverse reactions from the patients. The entire process was efficiently completed in just 45 minutes with only one injection required. The dual nature of imaging facilitated a clearer understanding of the pathologies presenting across both angiographic types. Simultaneous imaging demonstrated its potential for uncovering features obscured in traditional imaging methods.

Advantages and Future Perspectives

The ability to swiftly obtain simultaneous angiographic images represents a paradigm shift that promises streamlined workflows in ophthalmological practice. By facilitating real-time analysis, clinicians can obtain faster diagnoses, incorporate tailored treatment strategies, and elevate patient care standards overall. Implementing this advanced technology hints at a more efficient future in retinal imaging and its implications across broader medical practices.

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