Search Results (35)

Background/Objectives: In the setting of breast surgery, indocyanine green angiography (ICGA) allows estimating the perfusion of cutaneous tissues during surgical interventions, in order to reduce vascularization-related complications. This study has a dual objective: to evaluate the correlation between preoperative factors and the level of skin vascularization, measured by ICGA, in patients undergoing subcutaneous mastectomy for breast cancer; and to establish any relationship between low intraoperative vascularization and the onset of postoperative complications. Methods: This is a preliminary, non-randomized, prospective clinical study that includes 46 female patients undergoing subcutaneous mastectomy with reconstruction for breast cancer between February 2022 and July 2024. The relationship between vascularization and the following preoperative variables was assessed: smoking, previous breast surgeries, prior radiotherapy, neoadjuvant or prior chemotherapy/anti-Her2 therapy, and the thickness of breast subcutaneous tissue evaluated through mammography. For the analysis, three ICGA procedures were performed, using 0.125 mg/kg of indocyanine green (ICG) for each procedure before the surgical incision (V1), at the end of the demolition phase (V2), and at the end of the reconstruction phase (V3). The results of this analysis were finally correlated with the occurrence of any postoperative complications. Results: Vascularization was conventionally classified as “low” and “good” using a cutoff of 33%. Previous surgeries on the ipsilateral breast and neoadjuvant or prior chemotherapy/anti-Her2 therapy were found to be predictive factors of “low” vascularization (p = 0.031). Patients with “low” vascularization at time V3 showed a significantly higher risk of developing complications (p = 0.038). Incision length emerged as an independent predictor of complications, with a 23% increase in risk per additional centimeter (p = 0.006), independent of perfusion level. Conclusions: This study supports the use of ICGA as a useful tool to improve outcomes in patients undergoing subcutaneous mastectomy with prosthetic reconstruction for breast cancer. The results of this preliminary work are encouraging, and recruiting a larger number of patients could provide more significant data. Full article

Background/Objectives: The aim was to investigate the short-term outcomes of three consecutive monthly aflibercept 8 mg administrations for treatment-naïve eyes with exudative age-related macular degeneration (AMD). Methods: Twenty-one eyes with exudative AMD were included (type 1 macular neovascularization: eleven eyes; type 2 macular neovascularization, four eyes; and polypoidal choroidal vasculopathy (PCV), six eyes). All eyes received three consecutive monthly administrations of aflibercept 8 mg (114.3 mg/mL) at an injection volume of 0.07 mL. Indocyanine green angiography (ICGA) was performed on eyes with PCV at baseline and at the 3-month visit. Results: The best-corrected visual acuity significantly (BCVA) improved from 0.31 ± 0.38 (baseline) to 0.25 ± 0.38 at the 3-month visits (p = 0.035). Dry macula achieved 62% and 100% at the 1-month and 3-month visits, respectively. Central retinal thickness and subfoveal choroidal thickness significantly decreased by 55.7% and 19.8%, from 341 ± 112 (baseline) to 190 ± 64 (3-month visits) and from 192 ± 50 (baseline) to 154 ± 51 (3-month visits), respectively (both p < 0.001). Complete regression of polypoidal lesions was seen in five (83.3%) eyes out of six on ICGA at the 3-month visit. No systemic adverse events were noted, and one eye developed a retinal pigment epithelial tear one month after the first injection. Conclusions: Three consecutive monthly administrations of aflibercept (8 mg) were safe and effective for resolving exudation and polyp regression, with significant BCVA improvement in treatment-naïve eyes with exudative AMD. Full article

Background: Breast reconstruction with implants is now the preferred procedure following mastectomies. For successful reconstruction, accurate evaluation of the patient and skin flap viability is essential. This study aimed to analyze the impact of risk factors on mastectomy skin flap necrosis (MSFN) and the effectiveness of indocyanine green angiography (ICGA) in preventing complications. Methods: Fifty consecutive patients undergoing mastectomy were divided into two groups (arms A and B) based on the method of skin flap evaluation (ICGA vs. clinical assessment, respectively). Demographic details and the risk factor incidence were collected, and complication rates were compared between the two groups. Univariate analysis was conducted to identify correlations between mastectomy skin flap necrosis and the aforementioned risk factors. Results: The two groups showed comparable demographics and incidences of risk factors. Patients in arm A exhibited a lower rate of complications and reinterventions, although no significant differences were observed. Statistical analysis revealed a significant association between BMI, implant volume, and MSFN. Conclusions: ICGA proves to be an effective diagnostic tool for assessing skin flap viability. When coupled with meticulous patient selection, it aids in preventing complications. Full article

Objectives: To report ophthalmological and microvascular findings in patients with post-acute COVID-19. Methods: In this prospective, monocentric cohort study, we included patients with post-acute COVID-19 who presented with ophthalmological symptoms. All patients underwent indocyanine green angiography (ICGA), OCT, OCT-angiography, adaptive optics, and GlycoCheck assessments. Results: We included 44 patients, predominantly female (81.8%), with a mean age of 47.5 ± 11.5 years. Key ICGA findings revealed hyperreflective dots in 32 eyes (36.4%) and hemangioma-like lesions in 7 eyes (8.0%). Capillary non-perfusion in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was observed in 42 eyes (47.7%) and 21 eyes (23.9%), respectively. Eyes with hyperreflective dots exhibited a lower perfused boundary region (PBR), while those with superficial punctate keratitis showed a higher PBR (p = 0.02 and p = 0.002, respectively). Eyes with capillary non-perfusion in the SCP displayed lower capillary densities (CD4, CD5, and CD4-6; p = 0.001, 0.03, and 0.03, respectively), and eyes with non-perfusion in the DCP had lower CD4 (p = 0.03). A negative correlation was identified between capillary density and the wall-to-lumen ratio. Conclusions: Patients with post-acute COVID-19 demonstrate both retinal and choroidal vascular anomalies. Ocular pathology was associated with reduced capillary density. These injuries appear to stem more from microvascular disruptions than from persistent glycocalyx abnormalities. Full article

Background/Objectives: To evaluate the clinical performance of two optical coherence tomography angiography (OCTA) devices, including a semi-automated device, with respect to image quality and pathology detection, with fluorescein angiography (FA) and indocyanine green angiography (ICGA) serving as the reference standards. Methods: In this prospective cross-sectional study, normal eyes and those with various retinal and choroidal pathologies were enrolled and underwent OCTA scanning using semi-automated 3D OCT-1 Maestro2 and Cirrus™ HD-OCT 5000 devices, as well as FA/ICGA imaging. OCTA scans and FA/ICGA images were independently graded for image quality and the visibility of prespecified anatomic vascular features, along with the presence or absence of pathology on the OCTA scans and the FA/ICGA images (within regions corresponding to the OCTA scan areas). Positive percent agreement (PPA), defined as the proportion of eyes in which the OCTA demonstrated pathology when the corresponding FA/ICGA showed pathology, and negative percent agreement (NPA), defined as the proportion of eyes in which the OCTA showed no pathology when the FA/ICGA also showed no pathology, were calculated. Results: In total, 38 normal eyes and 86 pathologic eyes were enrolled in the study. The majority of images for both devices were considered clinically useful. The PPA and NPA were high for both devices, indicating a good ability to identify disease when present and to rule it out when not present. Conclusions: The findings of this study suggest that the semi-automated Maestro2 and Cirrus have comparably good clinical performance, particularly with regard to accuracy when identifying vascular pathologies. Full article

Objectives: The main objective of this study was to report and investigate the characteristics and longitudinal changes in dark-without-pressure (DWP) fundus lesions in patients with autoimmune diseases using multimodal imaging techniques. Methods: In this retrospective observational case series, five patients affected by ocular and systemic autoimmune disorders and DWP were examined. DWP was assessed by multimodal imaging, including color fundus photography (CFP), near-infrared reflectance (NIR), blue reflectance (BR), blue autofluorescence (BAF), optical coherence tomography (OCT), OCT-angiography (OCT-A), fluorescein angiography (FA) and indocyanine green angiography (ICGA), and functional testing, including standard automated perimetry (SAP) and electroretinography (ERG). Follow-up examinations were performed for four out of five patients (range: 6 months–7 years). Results: DWP fundus lesions were found in the retinal mid-periphery and were characterized by the hypo-reflectivity of the ellipsoid zone on OCT. DWP appeared hypo-reflective in NIR, BR and BAF, and exhibited hypo-fluorescence in FA in two patients while showing no signs in one patient. ICGA showed hypo-fluorescent margins in one patient. SAP and ERG testing did not show alterations attributable to the DWP lesion. Follow-up examinations documented rapid dimensional changes in DWP even in the short term (1 month). Conclusions: This study suggests a possible association between autoimmune diseases and DWP. New FA and ICGA features were described. The proposed pathogenesis hypotheses may operate as a basis for further investigation of a lesion that is still largely unknown. Large population studies would be necessary to confirm whether there is a higher incidence of DWP in this patient category. Full article

Two of the greatest challenges in breast reconstruction are mastectomy skin flap necrosis (MSFN) and autologous flap failure. This review summarizes current evidence regarding the usage of indocyanine green angiography (ICGA) in breast reconstruction, identifies knowledge gaps, and provides directions for future studies. An umbrella review was conducted to identify related syntheses in Embase, Ovid Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Clinical Trials databases. Data were extracted from systematic reviews (SRs) and meta-analyses (MAs) that discussed the use of ICGA in breast reconstruction. Sixteen syntheses were included (10 SRs and 6 MAs). Syntheses showed much evidence that ICGA usage typically reduces MSFN rates. However, it tends to overpredict necrosis and is best utilized in high-risk patients or those with an unclear clinical picture. ICGA is also useful in autologous breast reconstruction by reducing rates of breast fat necrosis (BFN), total flap loss, and reoperation. ICGA usage may also aid in perforator mapping and selection intraoperatively, with minimal complication risk. Most syntheses had moderate quality scores; however, they were small with significant heterogeneity in protocols and complication definitions. The use of ICGA in breast reconstruction is safe and useful in decreasing rates of MSFN, BFN, and reoperation after free flap reconstruction. Full article

Toxoplasma gondii, an obligate intracellular parasite, is a globally prevalent pathogen capable of infecting a wide range of warm-blooded animals, including humans. Ocular toxoplasmosis (OT), a severe manifestation of T. gondii infection, can lead to potentially blinding complications. This comprehensive review delves into the current understanding of T. gondii biology, exploring its complex life cycle, diverse transmission routes, and strain diversity. This article provides an in-depth analysis of the clinical manifestations of OT, which can result from both congenital and acquired infections, presenting a spectrum of signs and symptoms. The review examines various diagnostic strategies employed for OT, including clinical examination, multimodal imaging techniques such as fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA), as well as laboratory tests including serology and molecular methods. Despite extensive research, the specific mechanisms underlying ocular involvement in T. gondii infection remain elusive, and current diagnostic options have limitations. Moreover, the treatment of active and recurrent OT remains a challenge. While existing therapies, such as antimicrobial agents and immunosuppressants, can control active infections, they do not offer a definitive cure or completely prevent recurrence. The clinical endpoints for the management of active and recurrent OT are also not yet well-established, and the available treatment methods carry the potential for adverse effects. This article highlights the need for future research to elucidate the pathogenesis of OT, investigate genetic factors influencing susceptibility to infection, and develop more sensitive and specific diagnostic tools. Enhancing global surveillance, implementing robust prevention strategies, and fostering multidisciplinary collaborations will be crucial in reducing the burden of OT and improving patient outcomes. This comprehensive review aims to provide a valuable resource for clinicians, researchers, and policymakers, contributing to a better understanding of T. gondii infection and its impact on ocular health. Full article

Background: Predicting the viability of the skin flaps after mastectomy is of high importance and significance in immediate breast reconstruction. Numerous methods have been used and are readily available. This review aims to describe and compare the current preferred perfusion assessment tools. Methods: Four major scientific databases—Web of Science, PubMed, Embase, and Scopus—were consulted to retrieve reviews, meta-analyses, clinical trials, experimental studies, and case reports focused on skin flap perfusion assessment following mastectomy. English-language articles published within the last 10 years were included. The most recent search was conducted on 31 July 2024. Results: A summary focused on the relevant information of all included studies was drafted, and the results of the studies have been synthetized and compared. A total of 58 studies have been included in this review. Conclusion: Indocyanine green angiography (ICG-A) is the preferred and most-used method of evaluating perfusion, especially in high-risk patients, while new technologies show promising results and might be of great interest in the future. Perfusion assessment tools complement and should not replace clinical evaluation. Full article

Background: Indocyanine green angiography (ICGA) is often used for diagnosis of, and as an indication to apply laser treatment for, central serous chorioretinopathy (CSC). Although photodynamic therapy (PDT) is effective against CSC, the details of the mechanism are unknown. To verify the effect of PDT, we compared the time of choroidal circulation before and after PDT in CSC patients, using ICGA. Methods: Seven eyes of seven patients (six male, one female) who were diagnosed with chronic CSC associated with serous retinal detachment (SRD) in the macular area and who underwent half-dose PDT were included. Wide-field ICGA images with an angle of 102° were taken and evaluated at the superior and inferior temporal quadrants. Choroidal circulation time (CCT) was defined as the time from the start of contrast filling in the choroidal artery to the first appearance of contrast filling in the temporal vortex vein ampulla. Results: The average CCT before and after PDT in the superior temporal vortex vein was 3.96 s and 5.41 s (p = 0.018), and 4.12 s and 5.02 s (p = 0.046) in the inferior temporal vortex vein, respectively. All SRD and choroidal vascular hyperpermeability areas dissolved after PDT. Conclusions: In this pilot study, half-dose PDT prolonged CCT in CSC patients, indicating the effect of selective vascular obstruction in the choriocapillaris. Full article

Background: Thyroidectomy constitutes an important portion of endocrine surgery procedures and is associated with various complications such as bleeding, recurrent laryngeal nerve injury, and postoperative hypoparathyroidsm. Effective parathyroid preservation during thyroid surgery is crucial for patient well-being, with current strategies heavily reliant on surgeon experience. Among various methods, Indocyanine Green Angiography (ICGA) offers a promising method for intraoperative assessment of parathyroid gland perfusion. Methods: In a retrospective study, patients undergoing bilateral thyroidectomy from January 2021 to January 2023 were analyzed, excluding those with previous thyroidectomy, parathyroid disease, or chronic kidney disease. The study compared a control group (n = 175) with an ICGA group (n = 120), using propensity score matching for statistical analysis. Matched cohorts included 120 patients in each group. The primary outcome of this study was identified as temporary postoperative hypoparathyroidism, with secondary outcomes including the rate of parathyroid reimplantation and the incidence of permanent postoperative hypoparathyroidism. Results: The ICGA group showed significantly more parathyroid autotransplantations (p < 0.01). While not statistically significant, the control group had a higher incidence of temporary postoperative hypoparathyroidism (p < 0.09). Rates of hypocalcemia on postoperative day 1 and permanent hypocalcemia were similar. Subgroup analysis indicated more postoperative day 1 hypoparathyroidism in the control group during central neck dissections (p < 0.049). Conclusions: Intraoperative ICGA use correlated with higher parathyroid autotransplantation and suggested reduced postoperative hypoparathyroidism. Changes in fluorescence intensity following a second ICG injection may provide an objective method to assess parathyroid perfusion. Further large-scale studies are needed to fully understand ICGA’s impact on parathyroid preservation. Full article

To obtain a quantitative parameter for the measurement of choroidal vascular hyperpermeability (CVH) on ultra-widefield indocyanine green angiography (UWICGA) using an objective analysis method in macular choroidal neovascularization (CNV). A total of 113 UWICGA images from 113 subjects were obtained, including with 25 neovascular age-related macular degeneration (nAMD), 37 with polypoidal choroidal vasculopathy (PCV) (19 with thin-choroid and 18 with thick-choroid), 33 with pachychoroid neovasculopathy (PNV), and 18 age-matched controls. CVH was quantified on a gray image by the subtraction of 2 synchronized UWICGA images of early and late phases. The measured CVH parameter was compared with human graders and among CNV subtypes and correlated with choroidal vascular density (CVD) and subfoveal choroidal thickness (SFCT). The mean CVH values were 28.58 ± 4.97, 33.36 ± 8.40, 33.61 ± 11.50, 42.19 ± 13.25, and 43.59 ± 7.86 in controls and patients with nAMD, thin-choroid PCV, thick-choroid PCV, and PNV, respectively (p < 0.001). CVH was higher in thick-choroid PCV and PNV compared to the other groups (all p ≤ 0.006). The measured CVH value positively correlated with those reported by human graders (p < 0.001), CVD, and SFCT (p = 0.001 and p < 0.001, respectively). CVH can be measured objectively using quantitative UWICGA analysis. The CVH parameter differs among macular CNV subtypes and correlates with CVD and SFCT. Full article

Our purpose is to describe blue-light fundus autofluorescence (BAF) features of inflammatory diseases of the outer retina characterised by photoreceptor damage. BAF from patients diagnosed with secondary and primary inflammatory photoreceptor damage were retrospectively analyzed and compared to other imaging modalities including fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT). Multiple evanescent white dot syndrome (MEWDS), idiopathic multifocal choroiditis (MFC), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and acute syphilitic posterior placoid chorioretinitis (ASPPC), all cases corresponding to secondary photoreceptor diseases caused by inflammatory choriocapillaris nonperfusion, were included and compared to primary photoreceptor disease entities, including acute zonal occult outer retinopathy (AZOOR) and cancer-associated retinopathy (CAR). Both groups showed increased BAFs of variable intensity. In severe cases of APMPPE and ASPPC, BAF also showed hypoautofluorescent areas. In group 1 (secondary diseases) BAF hyperautofluorescent areas were associated with colocalized ICGA hypofluorescent areas, indicating choriocapillaris nonperfusion; whereas in group 2 (primary diseases), no ICGA signs were detected. The associated colocalized areas of hypofluorescence on ICGA in the first group, which were absent in the second group, were crucial to allow the differentiation between primary (photoreceptoritis) and secondary (choriocapillaritis) photoreceptor diseases. BAF patterns in inflammatory diseases of the outer retina can give relevant information on the photoreceptor and RPE involvement, with ICGA being crucial to detect concurring choriocapillaris damage and differentiating the two pathologies. Full article

The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a “tangled vasculature” pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management. Full article

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD) that is characterized by a branching neovascular network and polypoidal lesions. It is important to differentiate PCV from typical nAMD as there are differences in treatment response between subtypes. Indocyanine green angiography (ICGA) is the gold standard for diagnosing PCV; however, ICGA is an invasive detection method and impractical for extensive use for regular long-term monitoring. In addition, access to ICGA may be limited in some settings. The purpose of this review is to summarize the utilization of multimodal imaging modalities (color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (FAF)) in differentiating PCV from typical nAMD and predicting disease activity and prognosis. In particular, OCT shows tremendous potential in diagnosing PCV. Characteristics such as subretinal pigment epithelium (RPE) ring-like lesion, en face OCT-complex RPE elevation, and sharp-peaked pigment epithelial detachment provide high sensitivity and specificity for differentiating PCV from nAMD. With the use of more practical, non-ICGA imaging modalities, the diagnosis of PCV can be more easily made and treatment tailored as necessary for optimal outcomes. Full article