Angiography indocyanine green (ICG) is a technique that is useful for the diagnosis and therapeutic management of patients with macular degeneration for the treatment of exudative forms of AMD where the neovascular membrane (CNV) remains hidden behind the performance of a conventional fluorescein angiography (AGF). Keep in mind that laser photocoagulation of CNV is currently the only effective treatment for wet AMD proven. The efficacy of treatment depends largely on the accuracy with which the location and extent of the membrane is determined.
It is a form that uses a particular dye (indocyanine) to detect leaks or damage caused in the blood vessels that nourish the retina. Indocyanine green activates its coloring ability in the presence of invisible infrared rays. For this, there are sophisticated cameras sensitive to these rays of light. Angiography is used to study the deep vessels of the choroidal layer. It must be used in the treatment of age-related macular degeneration, where indocyanine is able to distinguish the deep vessels of the choroid, especially those that are hidden or blocked by blood. It has particular utility in the detection of variants of exudative DMAE such as polypoid choroidal vasculopathy. This may have determinants of therapeutic consequences. It can also identify new nutrients from the neovascular membranes, so they sometimes allow their direct treatment through photocoagulation and avoid reducing the use of intravitreal injections. The mode of application is the same as that of normal angiography: injecting the patient with the injection to travel through the blood and taking the photographs using a special camera.
10 cc dissolved. Water injection powder blister ICG is gently stirred so that no foam is made and removed 2.5 ml of mixture to inject the patient. (With a blister diluted voucher for four patients). When the test if excess is thrown away. You will then pass a syringe with saline to clear the line.
According to doctors to get tested, some prefer to do the ICG first and immediately the AGF and other backwards. AGF first and then the ICG.
Indocyanine Green Angiography (ICG) Process
The test is performed by injecting a dye intravenously into the forearm, and then photographs of the fundus with different filters are taken.
Indocyanine green angiography is a test consisting of performing a series of photographs of the fundus for 10-15 minutes.
The photographs are made after injecting an intravenous contrast, indocyanine green, which highlights the patient's blood vessels.
This test allows us to know the anatomical and functional status of the choroidal vascularization of the patient
As the ICG is a test that can last 30 or 40 minutes, there are times that patients who undergo the test are made to go with the path set to the waiting room, enters another patient to give you the next test, and then re-enter to end the test.
Then removed the catheter, and are told that the puncture site is tightened for five minutes.
Then you can go. No side effects.
(Patients allergic to iodine or shellfish cannot perform the test).
ADVANTAGES OF ANGIOGRAPHY WITH INDOCIANINE GREEN
- The main clinical indications for AVI are for age-related macular degeneration (AMD), polypoid choroidal vasculopathy, chronic central serous retinopathy and for Bruch's membrane tears.
- Indocyanine green angiography allows imaging of the choroidal circulation below the retinal pigment epithelium (RPE). It serves as a complement to fluorescein angiography, providing complementary information that helps define choroidal circulatory involvement in retinal pathology.
- Indocyanine green angiography is an imaging procedure to examine the choroid and vascular structure of the retina, which is enabled by the enlargement of the pupils with droplets and the intravenous administration of the indocyanine green dye in the arm.
- Green indocyanine binds 98% to plasma proteins in the blood, sparing scarce choroidal vessels. It plays an important role in the study and guided treatment of subretinal neovascularization (NVSR) associated with age-related macular degeneration (AMD). However, the interpretation of the angiogram is complex and requires experienced professionals.