Immunosuppressive treatment of choroidal neovascularization associated with endogenous posterior uveitis

OBJECTIVE: To determine whether resolution of choroidal neovascularization (CNV), a recognized sight-threatening complication of endogenous posterior uveitis, and maintenance of vision could be achieved with immunosuppression. PATIENTS AND METHODS: Fourteen patients (17 eyes) with CNV associated with endogenous posterior uveitis were enrolled in an open study. Ages ranged from 5 to 51 years. Three eyes had extrafoveal CNV, 6 juxtafoveal, and 8 subfoveal. Three patients were treated with a single course of oral corticosteroids, 2 had additional cyclosporine for up to 2 years, and 9 continued to receive a low-dose regimen of a combination of immunosuppressive drugs. RESULTS: After a median follow-up of 15 months (range, 7 months to 6 1/2 years), 9 of 17 eyes had an improvement in visual acuity; 6 remained within 1 Snellen line of initial visual acuity, and 2 had lost 2 Snellen lines. Angiographically, CNV resolved in 13 eyes, resolved then recurred in 3, and improved but persisted in 4. CONCLUSION: These results support a role for immunosuppressive therapy in the treatment of CNV associated with endogenous posterior uveitis.     

External beam radiotherapy (20 Gy, 2 Gy fractions) fails to control the growth of choroidal neovascularization in age-related macular degeneration: a review of 111 cases

BACKGROUND: Control of the natural course of choroidal neovascularization (CNV) in age-related macular degeneration (ARMD) is difficult, and laser photocoagulation is recommended in only a subset of patients. Alternative modalities of treatment are under investigation. METHODS: We have used external beam radiotherapy (20 gray radiation units [Gy], 2 Gy fractions) to treat CNV in ARMD. A total of 111 patients have been followed for 12-30 months after radiotherapy. This study evaluates the effect of radiotherapy on the size of CNV, which was digitally measured on serial fluorescein angiograms. RESULTS: Analysis of results in the classic (or mixed classic and occult) CNV group was conclusive for fast growth of CNV and continuous increase of size during follow up. In the occult CNV group, a slowly progressive growth of CNV was demonstrated. In patients with vascularized pigment epithelium detachments, "hot spots" persisted; in a few patients, flattening of the macula was observed. Nearly all treated patients experienced further loss of vision. CNV growth in the radiotherapy treated eye was usually similar to growth in the untreated fellow eye, and in some, even worse. CONCLUSION: External beam radiotherapy (20 Gy, 2 Gy fractions) failed to control growth of CNV and was ineffective in stabilizing vision.     

Successful bone marrow transplantation in a Chinese boy with Wiskott-Aldrich syndrome

BACKGROUND: Choroidal ruptures occurring as a result of blunt ocular injury are uncommon. A 72-year-old woman sustained blunt trauma to the left eye in 1965. In 1986, she was seen at the Wilmer Institute, and posterior choroidal rupture was documented and fluorescein angiography was performed. Absence of fluorescence was seen in the area of the rupture, and the inferotemporal artery and vein dipped into the area and emerged on the other side of the rupture. METHODS: The eyes were obtained postmortem, and histologic examination was performed. RESULTS: Examination of the left eye revealed a horizontal linear white scar inferior to the optic nerve and macula. Stepped-serial sections through the rupture revealed a 0.7-mm wide defect in Bruch's membrane and retina where fibrous tissue containing melanocytes extended into the vitreous cavity for a short distance. CONCLUSION: The clinicopathologic features of an indirect horizontal choroidal rupture is reported.     

Expression of cell adhesion molecules and vascular endothelial growth factor in experimental choroidal neovascularisation in the rat

AIMS: To investigate the longevity and reproducibility of choroidal neovascularisation (CNV) induced by krypton laser photocoagulation in the rat. The presence of cell adhesion molecules (CAMs) and vascular endothelial growth factor (VEGF) during the development of CNV was also studied. METHODS: 67 pigmented rats underwent retinal photocoagulation by krypton laser. The eyes were examined by either single or serial fluorescein angiography at 3 days, 1, 2-3, 4-5, 7-8, and 12 weeks post photocoagulation. The expression of CAMs (ICAM-1, E-selectin, and CD44) and VEGF post photocoagulation was studied by immunohistochemistry. RESULTS: CNV related fluorescein leakage appeared in 46.4% of 766 laser spots delivered to the 58 eyes that were tested at 2-3 weeks post treatment. The ratio of hyperfluorescent laser sites did not change significantly at 8 weeks post laser. The number of leaky spots was independent of the total number of lesions delivered to each eye (at 2-3 weeks post laser 10-15 spots/eye: 44% and 25-30 spots/eye: 49%; t = 0.7673; p = 0.3903). Nine eyes were followed by serial angiography between 2 and 12 weeks. The laser spots with fluorescein leakage at 2 weeks (51.5%) remained leaky at 12 weeks (51.5%). Histopathologically, macrophage accumulation peaked at 5 days and CNV was firstly observed at 1 week post photocoagulation. ICAM-1, E-selectin, CD44, and VEGF were maximally induced at 3-5 days post laser photocoagulation, and were localised to RPE, choroidal vascular endothelial, and inflammatory cells. VEGF was also detected in intravascular leucocytes at the sites of laser lesions. CONCLUSIONS: These studies demonstrated that krypton laser photocoagulation can be successfully used to produce lesions similar to those of human CNV. The response induced remained present for an extended period of time (12 weeks), thus offering a potential model to screen candidate CNV inhibitory agents. In addition, it is proposed that the expression of ICAM-1, E-selectin, CD44, and VEGF before new vessel formation might be linked to the initiation of CNV.     

Characterisation of the infarct-limiting effect of delayed preconditioning: timecourse and dose-dependency studies in rabbit myocardium

BACKGROUND: Although the choroidal neovascularization (CNV) is a common pathologic feature of a number of different eye diseases, its pathological mechanisms have not been fully elucidated. We investigated the expression of vascular endothelial growth factor (VEGF) in CNV using an experimental primate model. METHOD: CNV was induced by intense laser photocoagulation in four monkey eyes. Single eyes were enucleated at 1, 3, 7 or 14 days after photocoagulation and examined immunohistochemically for VEGF, macrophage antigen, von Willebrand factor and glial fibrillary acidic protein (GFAP). Expression of VEGF mRNA was examined by in situ hybridization. RESULTS: One day after photocoagulation, the normal structure of the outer portion of the retina and the inner portion of the choroid was destroyed. Three days after photocoagulation, choroidal vascular endothelial cells migrated into the subretinal space through the defect in Bruch's membrane. Increased expression of VEGF was detected in the accumulating macrophages, migrating retinal pigment epithelial (RPE) cells and Müller cells. Maximal expression of VEGF was observed between 3 and 7 days after wounding, and many newly formed vessels extended into the subretinal space 7-14 days after photocoagulation. CONCLUSION: VEGF derived from RPE cells, macrophages and Müller cells may play a role in the formation of CNV.     

Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age

PURPOSE: To study the clinical histories and courses of six patients with choroidal neovascularization secondary to endogenous Candida albicans chorioretinitis. METHODS: The medical records, fundus photographs, and fluorescein angiograms of six patients who developed C. albicans chorioretinitis secondary to candidemia and who subsequently developed choroidal neovascularization in one or both eyes were reviewed. RESULTS: The six patients ranged in age from 18 to 79 years. Four were women and two men; all but one showed evidence of bilateral chorioretinal scarring secondary to C. albicans chorioretinitis. All patients had been treated successfully with systemic antifungal therapy (amphotericin B). Two weeks to two years after the chorioretinitis, choroidal neovascularization developed in one eye (four cases) or both eyes (two cases). The neovascularization on initial examination was subfoveal in four eyes, extrafoveal in three eyes, and juxtafoveal in one eye. Laser photocoagulation was used in four of the eight involved eyes. In these cases, the active choroidal neovascularization was brought under control. In one eye, the patient had submacular surgery for excision of the choroidal neovascular membrane. Final visual acuities ranged from 20/20 to 20/200 in treated eyes and from 20/50 to 20/400 in untreated eyes. CONCLUSION: Choroidal neovascularization is a potential cause of late visual loss in patients who have had C. albicans sepsis and endogenous C. albicans chorioretinitis. Eyes that have chorioretinal scarring from C. albicans chorioretinitis should be watched for the development of choroidal neovascularization. Laser photocoagulation or perhaps surgical excision of the neovascular complex may be of benefit in selected cases.     

Clinicopathologic findings in recurrent choroidal melanoma after transpupillary thermotherapy

OBJECTIVE: This study aimed to report the clinicopathologic findings of recurrent choroidal melanoma after transpupillary thermotherapy (TTT). DESIGN: Two case reports. METHODS: The clinical histories and ophthalmologic findings of two patients with recurrent choroidal melanomas who did not respond to TTT were reviewed. Both patients had their eyes with the melanoma enucleated and processed routinely for light and electron microscopic examination. MAIN OUTCOME MEASURES: The eyes were examined for histopathologic and ultrastructural findings. RESULTS: Histopathologic examination showed choroidal melanomas with extensive tumor necrosis and hemorrhage. In areas, tumor cells appeared histologically intact and presumably viable, with ultrastructural evidence of melanogenesis. The eye from one patient was treated only with TTT and showed hemorrhagic necrosis with cytolysis and no changes to tissues surrounding the melanoma. The eye from the other patient, treated with TTT and a radioactive isotope of iodine (I125) plaque, exhibited areas of intact tumor, tumor necrosis, fibrosis, and radiation retinopathy. CONCLUSIONS: These two cases among a total treated series of 14 patients represent examples of uveal melanoma regrowth after TTT. Opaque media precluded adequate treatment in the first case that showed some TTT effect. The second case showed a combination of TTT and I125 effect and failed because of the aggressive nature of tumor.     

Choroidal neovascularization in second eyes of patients with unilateral exudative age-related macular degeneration

PURPOSE: To evaluate patients with unilateral occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) for the nature of the neovascularization which develops in the fellow eyes. METHODS: Patients with newly diagnosed unilateral occult CNV were followed prospectively for the development of CNV in the fellow eye. Patients were classified based on the type of occult CNV in the first eye: (1) those with associated serous pigment epithelial detachment (serous PED) and (2) those without. Demographic and clinical data, including the type of CNV in the second eyes, were compared. RESULTS: Choroidal neovascularization developed in 115 patients in the second eye. Fifty-six patients had occult CNV with a serous PED (also termed vascularized PED) in the first eye, and 59 patients had occult CNV without serous PED. The two groups did not differ significantly in the demographic and the clinical features evaluated. Well-delineated (or classic) CNV developed in the fellow eye of one patient in each group. Of the remaining 55 patients with vascularized PED in the first eye, the same type of occult CNV developed in 48 (87%) patients in the second eye. Of 58 (84%) patients in the second group, the same type of occult CNV developed in the second eye of 49 patients. This symmetric distribution of type of CNV between eyes is highly significant (P < 0.001). CONCLUSIONS: Eyes with occult CNV secondary to AMD can be classified by the presence or absence of an associated serous PED. Patients with unilateral occult CNV have a significant risk of occult CNV developing in the second eye, and the type of occult disease in the first eye is highly predictive of the type of neovascularized disease in the second eye. These findings are important with respect to natural history, and possibly to the treatment response and visual prognosis of patients with neovascularized AMD.     

Visual acuity and scar size in eyes with age-related subfoveal choroidal neovascular lesions, 30 months after radiation therapy

PURPOSE: In a study to determine the effectiveness of ionizing radiation on the deterioration of visual acuity (VA) due to choroidal neovascularisation (CNV) the affected eyes of 10 patients were treated with a total dose of 24 Gy (6 Gy fractions). A special lens-sparing technique was used to avoid cataract development. During 30 months of follow-up the visual acuity (VA) and scar size (SS) of the treated eyes and fellow eyes of all 10 patients were evaluated. RESULTS: After 30 months of follow-up 5 eyes showed a stable VA and fluorescein angiogram (FA) appearance. Concerning 4 out of 5 eyes with progressive disease, the 4 eyes treated with radiation therapy had better VA and smaller SS as compared with the untreated fellow eyes with exudative AMD. CONCLUSIONS: The results suggest that 24 Gy either stabilizes or delays the deleterious effects of CNV on the visual acuity. Until now no late side effects have been observed.     

Pharmacokinetics of hydroxocobalamin in smoke inhalation victims

PURPOSE: This study was performed to describe the clinicopathologic features of a group of patients with posttraumatic unilateral focal choroidal granulomatous inflammation. METHODS: Enucleated eyes with focal choroidal granulomatous inflammation without clinical signs of contralateral ocular inflammation were identified. Clinical and pathologic features were recorded. RESULTS: Six enucleated eyes that had been injured by projectiles had focal uveal granulomatous inflammation of the posterior choroid. Four eyes had uvea attached to or incarcerated into the wound. Two eyes had foreign material associated with the granulomatous inflammation, and two eyes had a disrupted lens with lens-induced inflammation. Two eyes exhibited the focal granulomatous inflammation at the site of a choroidal rupture. None of the six enucleated eyes contained Dalen-Fuchs' nodules. CONCLUSIONS: Focal choroidal granulomatous inflammation may occur as a result of penetrating ocular trauma. The origin of this condition is unknown, although it likely represents a reaction to a foreign body.     

Application of the dispersion model for description of the outflow dilution profiles of noneliminated reference indicators in rat liver perfusion studies

Recent investigations have raised the possibility that ocular diurnal rhythms might be involved in the regulation of eye growth. Specifically, the chick eye elongates with a daily rhythm, said to be absent in form-deprived eyes. The present study asks: (1) Which components of the eye have daily rhythms-only the overall eye size, or also choroidal thickness or anterior chamber depth? (2) Does the phase or amplitude of these rhythms differ in eyes growing either faster than normal (form-deprived eyes) or slower than normal (eyes recovering from form-deprivation myopia)? Using high-frequency A-scan ultrasonography that allowed fine (8-20 micron) resolution of anterior chamber depth, vitreous chamber depth, choroidal thickness and axial length, we measured normal eyes, form-deprived eyes and eyes recovering from form-deprivation myopia at 6 hour intervals for 5 days and 4 nights. All eyes showed daily rhythms in axial elongation and choroidal thickness. In both normal and form-deprived eyes, the axial length was greatest in the afternoon when the choroid was thinnest, and hence, these rhythms were approximately in anti-phase to one another; in addition, there is some evidence that the axial length rhythm in form-deprived eyes is phase-advanced relative to that of their fellow control eyes. The amplitude of the rhythm in choroidal thickness in form-deprived eyes was significantly larger than in normal eyes. In recovering eyes in which elongation is slowed, the rhythm in axial length was significantly phase-delayed relative to normal eyes (peak at 8 pm) and the rhythm in choroidal thickness was phase-advanced (peak at 8 pm); thus in these eyes, the two rhythms are in phase. In these eyes, the choroids were thickening by approximately 100 micron/day. In all three groups, the rhythm in anterior chamber depth appears to differ in phase from the rhythm in axial length (and hence from the rhythm at the posterior wall of the eye). We propose that the phase relationship between these choroidal and eye length rhythms influence the rate of growth of the eye, and conclude that diurnal ocular rhythms may be important in eye growth regulation.     

Focal proliferations of retinal pigment epithelium. Risk factor in senile macular degeneration

BACKGROUND: Clinical studies have demonstrated the relevance of focal RPE proliferations in early AMD as risk factors for visual loss caused by late AMD. Angiographically these focal RPE proliferations are characterized as small hypofluorescent spots with hyperfluorescent rim without leakage. Corresponding to histological and experimental studies they can be interpreted as small areas of occult choroidal neovascularizations covered by proliferated RPE cells. The characterization of the long-term prognosis of these lesions was the aim of the present study. PATIENTS AND METHODS: Ninety-eight patients (52 female, 46 male) were reexamined clinically and angiographically with a follow-up of 2-12 years (mean 6.5 years). RESULTS: Visual loss of two lines or more could be observed in 64.5% of patients with final visual acuity less than 20/100 in 24.5% of patients. Morphologically the changes in visual acuity were related to the progression towards classical choroidal neovascularizations in 32.7% of patients. In addition 11.2% of patients demonstrated a regression of the small occult membrane with the development of small areas of RPE atrophy covering the size of the original occult neovascularization. In 10.2% of the patients enlargement of the lesion was observed, resulting in a large occult choroidal neovascularization without signs of classical membranes, and in 45.9% of patients the clinical and angiographical situation was unchanged. The most important prognostic factor correlating with visual loss was the presence of a disciform lesion in the fellow eye and of multiple drusen in the examined eye. Other factors like the size or location of the focal RPE proliferation and the duration of follow-up did not correspond with visual loss. CONCLUSIONS: Focal RPE proliferations in early AMD interpreted as small occult choroidal neovascularizations are associated with a high risk of visual loss. Especially if these lesions are associated with multiple drusen and a disciform lesion in the fellow eye, nearly all patients are at risk for visual loss. These changes may therefore characterize a special high-risk group for future prophylactic treatments in early AMD, but because of the high risk for the development of classical choroidal neovascularizations in this group, these results are also very important for the planning of prophylactic laser trials for drusen in early AMD.     

DNA damage triggers DRB-resistant phosphorylation of human p53 at the CK2 site

OBJECTIVE: To describe the comparative impact of current and preventive treatments on incidence of choroidal neovascularization (CNV) and severe vision loss in patients with bilateral soft drusen (BSD). DESIGN: Stochastic model. SETTING: US population. PATIENTS: Prevalence cohort of white patients 43 years or older with BSD. INTERVENTIONS: Application of prophylaxis of 10% to 50% efficacy to 1 or both eyes of patients with BSD, application of laser photocoagulation to eligible CNV lesions, or both. MAIN OUTCOME MEASURES: Proportion of patients with BSD after 10 years with unilateral and bilateral CNV and resultant unilateral and bilateral vision loss to visual acuity of 20/200 or worse. RESULTS: The natural history of patients with BSD generated by the model shows that 12.40% of these patients develop either unilateral or bilateral CNV within 10 years of their entry into the BSD prevalence cohort. Bilateral disease occurs in 3.86% of patients with BSD within 10 years. The proportion of patients with BSD becoming legally blind from CNV within 10 years is 2.54% if no treatment is performed. Current laser treatment for CNV decreases the proportion with legal blindness within 10 years to 2.24%. The addition of a preventive treatment of 10% efficacy applied bilaterally to the current laser treatment regimen decreases the proportion with legal blindness to 1.86%; a 25% effective preventive treatment decreases it to 1.34%. Comparatively, preventive treatment of 10% and 25% efficacy given to the fellow eye only after the first eye has developed CNV decreases the proportion of legally blind patients at 10 years only to 2.06% and 1.77%, respectively. All outcomes vary with sex and age at entry into the BSD cohort. CONCLUSIONS: Patients with BSD face a 12.40% risk of developing CNV within 10 years. The addition of even a modest (10% effective) bilateral preventive treatment to the current regimen for CNV would more than double the prevention of legal blindness in the BSD population relative to current laser treatment; a preventive treatment of 33% efficacy more than halves the rate of legal blindness caused by CNV. Preventive treatment given to the fellow eye only after the first develops CNV has substantially less impact.     

Perifoveal laser treatment for subfoveal choroidal neovascularization in age-related macular degeneration

The management of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration presents a major therapeutic dilemma. No treatment may lead to severe visual loss, and direct laser treatment to the entire subfoveal lesion results in acute loss of visual acuity. Encouraging results have been described with a foveal-sparing laser technique for subfoveal CNV. The authors performed perifoveal confluent laser treatment on a relatively well-defined occult CNV, sparing the foveal avascular zone. One month after treatment, the visual acuity had improved from 20/400 to 20/30. At 24 months, the visual acuity was 20/40 with no recurrence. Confluent perifoveal laser treatment for subfoveal CNV may be useful in preserving central visual acuity in selected patients.     

Cholelithiasis following gastric surgery]

"Classic" choroidal neovascularization (CNV) has a relatively uniform appearance in fluorescein angiography. In contrast, indocyanine green (ICG) angiography shows variable features of well-defined CNV. We examined 31 classic CNV patients secondary to age-related macular degeneration using a confocal laser scanning ophthalmoscope (Heidelberg Retina Angiograph) in order to determine ICG characteristics of classic CNV. Vascular patterns (97%), a hypofluorescent rim (84%), a hyperfluorescent margin (42%), late ICG leakage (32%) and "feeder vessels" were identified in variable frequency. Some of the ICG characteristics may correlate with histological features of the membrane and reflect proliferative activity. Extrafoveal "feeder vessels" may be amenable to laser photocoagulation in the presence of subfoveal CNV.     

Combined iodine-125 plaque irradiation and indirect ophthalmoscope laser therapy of choroidal malignant melanomas: comparison with iodine-125 and cobalt-60 plaque radiotherapy alone

The authors studied the short-term impact of combined episcleral iodine-125 plaque radiotherapy and argon laser treatment in a series of 24 patients with choroidal malignant melanoma. All patients underwent plaque therapy prior to their initial laser session. All laser treatments were performed with an indirect ophthalmoscope argon green laser, using low-power, long-duration exposures. The endpoint of laser therapy was a well-defined atrophic circumbasal chorioretinal laser scar and complete or nearly complete nonfluorescence of the lesion on fluorescein angiography. In a case-by-case matched comparison study, the authors evaluated the relative local regression of tumors treated by combined plaque-laser therapy, iodine-125 plaque therapy alone, and cobalt-60 plaque therapy alone. The tumors treated with supplemental laser regressed substantially faster and more completely than did those treated by either type of plaque therapy alone. However, the short-term visual loss was greater in eyes treated by the combined therapy.     

Pseudophakic retinal detachment in high axial myopia

PURPOSE: To investigate the effect of extracapsular cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG (Nd:YAG) laser posterior capsulotomy on the rate of retinal detachment (RD) in myopic eyes with an axial length of 27 mm or more. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: This retrospective, nonrandomized study comprised the records of 386 consecutive surgical procedures in 275 patients performed between December 1985 and December 1993. In May 1994, all patients were asked by a mailed questionnaire whether they had had an RD in either eye or laser treatment for posterior capsule opacification. Responses from 190 patients concerning 253 surgical procedures were evaluated. RESULTS: The pseudophakic RD rate was 0.8% (two cases). One patient developed aphakic RD after IOL explanation. One expulsive choroidal hemorrhage occurred during secondary IOL implantation. Four eyes (1.6%) had vitreous loss, and 74 eyes (29.2%) had an Nd:YAG capsulotomy. Mean axial length was 29.2 mm +/- 1.71 (SD), mean follow-up was 3.8 +/- 2 years, and mean age at surgery was 69.8 +/- 12 years. CONCLUSION: Pseudophakia with no other risk factor posed little additional risk for RD in eyes with high axial myopia; however, Nd:YAG laser posterior capsulotomy was a risk factor for pseudophakic RD. Complicated surgery, such as a secondary procedure or vitreous loss, and young age were major causative factors.     

Digital subtraction indocyanine green angiography of occult choroidal neovascularization

OBJECTIVE: This study aimed to use a new technique for ocular imaging, digital subtraction indocyanine green angiography (DS-ICGA), to evaluate patients with occult choroidal neovascularization (CNV). DESIGN: The design was a cross-sectional study of patients with occult CNV. PARTICIPANTS: A total of 31 eyes of 31 patients were studied. INTERVENTION: Digital subtraction of sequentially acquired indocyanine green angiographic frames was used to image the progression of the dye front in eyes with occult CNV. A method of pseudocolor imaging of the choroid was developed that allows differentiation and identification of underlying choroidal arteries and veins. RESULTS: The DS-ICGA of occult CNV showed consistent findings. Occult CNV was imaged with greater detail and in a shorter period of time than with conventional indocyanine green angiography. The fundus landmarks were retained with DS-ICGA much better than with conventional indocyanine green angiography. CONCLUSIONS: The DS-ICGA uses time to dissect the choroidal circulation. With DS-ICGA, occult CNV could be imaged more quickly and in greater detail than with conventional imaging techniques. The DS-ICGA may improve the authors ability to image, and subsequently treat, occult CNV.     

Comparison of indocyanine green and fluorescein angiography of choroidal neovascularization

We compared indocyanine green (ICG) and fluorescein angiography for evaluation of choroidal neovascularization (CNV). Cast preparations of CNV induced in monkey eyes by laser photocoagulation were correlated with ICG and fluorescein angiographies of the same CNV formations. Fluorescein angiography was more effective, in general, than ICG angiography in detecting CNV; however, CNVs with subretinal hemorrhage (2 of 35 sites) were visible only with ICG angiography. In early phase ICG angiography, CNV formations that casts showed to be dense or composed of thick vessels were seen, but less dense areas were not visible. Lesions that ICG angiography revealed as leaking were not differentiated morphologically from non-leaking areas by the CNV casts. This study confirms that only ICG angiography can identify CNV hidden by subretinal hemorrhage, although fluorescein angiography is otherwise superior. Indocyanine green angiography is indicated as a valuable complement to fluorescein angiography for evaluation of CNV.