Indocyanine Green Angiography is photographic surveillance of the passage of Indocyanine Green passing by choroidal blood vasculature.

1. Indocyanine Green
Angiography
Hasnain Pasha
(Optometry Student)
10th September, 2018

2. @HasnainPashaPK
Properties of Indocyanine Green Dye
Advantages of ICGA over FFA
Indications of ICGA
Principle of ICGA
Phases of ICGA
Adverse Effects of ICGA
Contraindications of ICGA

3. @HasnainPashaPK
Indocyanine Green
• Indocyanine Green (ICG) is a water-soluble, tricarbocyanine dye.
• Empirical formula is C43H47N2O6S2Na.
• It contains less than 5% sodium iodide in order to increase its solubility.
• It has a pH of 5.5 to 6.5 in the dissolved state.
• ICG has a half life of 150 to 180 seconds.
• Absorbs light between 600 nm and 900 nm and emits fluorescence
between 750 nm and 950 nm.
• Peak absorption at 805 nm, and peak emission around 835 nm.
• The large overlapping of the absorption and fluorescence spectra leads
to a marked reabsorption of the fluorescence by ICG itself.

4. @HasnainPashaPK
Indocyanine Green
• It comes packed as a sterile lyophilized powder and is supplied with an
aqueous solvent.
• Color: Dark Green, Blue-Green, Olive Brown, Dark Blue, or Black Powder.
• It has limited stability, hence must be used within 10 hours after
reconstitution.
• ICG fluorescence is only 1/25th or 4% that of fluorescein.
• The dye is secreted unchanged by the liver into the bile.
• There is no renal excretion and it does not cross the placenta.

5. @HasnainPashaPK
Advantages of ICGA over FFA
• FA is excellent method of studying the retinal circulation, it is of limited use in delineating the choroidal
vasculature, due to masking by the RPE.
• The near-infrared light utilized in ICGA penetrates ocular pigments such as melanin and xanthophyll, as well as
exudate and thin layers of subretinal blood, making this technique eminently suitable.
• ICGA can be used even when the ocular media are too hazy for FFA because infrared light is less scattered
than visible light.
• 98% of ICG molecules bind to serum protein, thus remain in choroidal vessels.
• Photophobic patients tolerate ICGA better than FFA.

6. @HasnainPashaPK
Indications of ICGA
• Polypoidal choroidal vasculopathy (PCV): ICGA is far superior to FFA for the imaging pf PCV.
• Exudative age-related macular degeneration: Conventional FFA remains the primary method of assessment, but ICGA can
be useful adjunt, particulary if PCV is suspected.
• Chronic central serous chorioretinopathy in which it is often difficult to interpret areas of leakage on FFA. However, ICGA
shows choroidal leakage and the presence of dilated choroidal vessels. Previously unidentified lesions elsewhere in the
fundus are also frequently visible using ICGA.
• Posterior uveitis: ICGA can provide useful information beyond that available from FFA in relation ti diagnosis and the
extent of disease involvement.
• Choroidal tumors may be imaged effectively but ICGA is inferior to clinical assessment for diagnosis.
• Breaks in Bruch membrane such as lacquer cracks and angioid streaks are more effectively defined on ICGA than on FFA.
• If FFA is contraindicated.

7. @HasnainPashaPK

8. @HasnainPashaPK

9. @HasnainPashaPK

10. @HasnainPashaPK

11. @HasnainPashaPK
Adverse Effects of ICGA
• ICGA is generally better tolerated than FAA.
• Nausea, vomiting, and urticaria are uncommon.
• Anaphylaxis occurs with approximately equal incidence to FFA.
• Serious reactions are exceptionally rare

12. @HasnainPashaPK
Contraindications of ICGA
• ICG contains iodide and so should not be given to patients allergic to iodine.
• ICGA is contraindicated in liver disease.
• In patients with history of severe reaction to any allergen, moderate, or sever asthma.
• In patients with significant cardiac disease.
• Its safety in pregnancy has not been established.

13. @HasnainPashaPK
Refrences
• Diagnostic Procedures in Ophthalmology 2ed (JAYPEE – HV Nema, Nitin Nema)
• Kanski’s Clinical Ophthalmology 8ed
• Wikipedia.org
• Pubchem.ncbi.nlm.nih.gov

14. You don’t see well? See an Optometrist!
- Hasnain Pasha