Indocyanine green angiography: An evaluation of image enhancement for the identification of occult choroidal neovascular membranes

Purpose: To determine the diagnostic yield of occult choroidal neovascularization from examination of nonenhanced digital indocyanine green (ICG) angiograms versus examination of both nonenhanced and contrast-enhanced angiograms. Methods: Fifty consecutive occult choroidal neovascular membranes were examined using ICG angiography at the Queen's University Eye Department. These studies were retrospectively reviewed in a masked fashion using the nonenhanced images. A subsequent examination of the same images was then performed using both the nonenhanced and contrast-enhanced images. Each study was graded as focal hyperfluorescence, plaque hyperfluorescence, isofluorescence, or hypofluorescence. Results: Of the cases reviewed, only 36% (18/50) of the membranes were well-defined on nonenhanced ICG angiography, compared with 58% (28/50) using image enhancement in addition to the nonenhanced images. This was a statistically significant difference in image definition between the two groups (chi-square test; P < 0.005). Conclusion: Contrast-enhanced angiograms, when used in conjunction with nonenhanced ICG images, allowed for a significantly higher diagnostic yield when compared with the study of nonenhanced images alone.