Search PubMed⌕ Search

Biomedical subjects

C P Herbort

Publications and source records attributed to C P Herbort.

At least 19 recordsLinked to original sources
PubMed2004

Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data.

BACKGROUND: If medical treatment fails in uveitic glaucoma a surgical approach should be considered. Classical trabeculectomy is known to have a less favourable outcome in uveitis. Our intention is to report the first series of uveitis patients with glaucoma resistant to medical therapy who were treated with deep sclerectomy (DS). PATIENTS AND METHODS: Fourteen eyes of 13 patients (mean age 39.0 +/- 18.5 years; range 8 to 76 years) with chronic uveitis underwent non-penetrating filtering surgery from 1995 to 2003. All patients had their uveitis controlled before and after surgery by immunomodulatory therapy. Non-penetrating filtering surgery consisted of DS with collagen implant (Staar(R)) in 4 eyes, DS with draining device (T-Flux Ioltech(R)) in 2 patients, DS without implant in 7 patients and with viscocanalostomy in 1 patient. Nine eyes (65 %) received mitomycin C peri-operatively. RESULTS: Intra-ocular pressure (IOP) was reduced from a mean pre-operative value of 42.8 +/- 13.6 mmHg to a 1-year mean post-operative value of 12.1 +/- 4.0 (71.7 % reduction). Eleven of the 14 eyes completed 12 months of follow-up, resulting in complete success in 5 (45.4 %) and in qualified success in 5 (45 %) and in failure in one patient (9.2 %), later controlled by a second operation. Anti-glaucomatous medication was reduced from a mean of 3.7 +/- 0.5 medications preoperatively to 1.2 +/- 0.8 medications (71.4 % reduction) at the 12 month follow-up. Nine of the 14 patients achieved a 24 month follow-up with a mean IOP of 14.1 +/- 3.8 mmHg and mean of anti-glaucomatous medications of 1.6. Four patients have been examined 4 years after the DS: mean IOP was 13.2 +/- 2.2 mmHg and mean medication 1.7 +/- 1.0. Post-operative complications included one case of lens opacity and 2 cases of hypotony lasting for five months and four weeks after the intervention respectively. CONCLUSION: Non-penetrating filtering surgery controlled the intra-ocular pressure in 90 % of eyes with uveitic glaucoma resistant to medical therapy at 12 months. Surgical complications were low which may explain the high success rate of the procedure, compared to classical penetrating surgery.

Adolescent↗
PubMed2004

Differential inflammatory involvement in retina and choroïd in birdshot chorioretinopathy.

BACKGROUND: Birdshot chorioretinopathy is characterised by dual unrelated inflammatory involvement of the retina and the choroid. Indocyanine green angiography made it possible to assess and follow choroidal disease with the same precision as retinal involvement was followed so far. The aim of this study was to analyse the severity, progression and response to therapy of both retinal involvement using fluorescein angiography and choroidal involvement using indocyanine green angiography. PATIENTS AND METHODS: Patients with birdshot retinochoroidopathy followed at La Source Eye Centre in Lausanne, Switzerland from January 1995 to December 2002 were subdivided into three subgroups according to the duration of evolution of the disease: untreated patients with no more than one year duration of the disease (group 1, n = 6); treated patients with disease duration of 1 - 7 years duration (group 2, n = 5) and patients with disease lasting for more than 7 years (group 3, n = 4). Fluorescein and indocyanine green angiographic signs (angiographic scores given by a masked observer) were analysed in the 3 groups and compared to the "cream-coloured" fundus lesions. RESULTS: Fifteen out of the 742 patients (2.0 %) seen at La Source Eye Centre during the time period considered presented BC and were included in the study. In the "early disease group" fluorescein and ICG angiography showed more severe choroidal than retinal involvement with respective scores of 3 +/- 0.79 (ICG) and 2 +/- 1.17 (FA) while there were few depigmented fundus lesions to be seen (score 1 +/- 0.27). The choroidal involvement responded well to systemic corticosteroids +/- immunosuppressive therapy (scores in groups 2 and 3 = 1.2 and 0.75), while retinal disease was stabilised at best (scores in groups 2 and 3 = 2.2. and 2.4) and depigmented fundus lesions increased (scores in groups 2 and 3 = 2.8 and 3). CONCLUSION: The evolution and response to therapy of retinal and choroidal disease in birdshot chorioretinopathy have a different course with choroidal disease responding well to therapy while retinal disease is more resistant, possibly explaining the slow deterioration of functional parameters despite therapy. The increase of "cream-coloured" fundus lesions despite good choroidal response to therapy could be explained by depigmentation left behind after resolution of choroidal stromal granulomas, a hypothesis recently confirmed by an autopsy case of birdshot chorioretinopathy.

Adrenal Cortex Hormones↗
PubMed2001

The contribution of indocyanine green angiography to the appraisal and management of Vogt-Koyanagi-Harada disease.

OBJECTIVE: The goal of this study was to analyze indocyanine green angiographic (ICGA) findings in Vogt-Koyanagi-Harada (VKH) disease and to determine their value in assessing choroidal involvement as well as their use for diagnostic and follow-up purposes. DESIGN: Retrospective and prospective observational, interventional case series. PARTICIPANTS: Ten patients with VKH disease documented with, for the retrospective cases, at least one concomitant fluorescein and indocyanine green angiogram and, for the prospective cases, follow-up angiograms performed regularly. TESTING: Indocyanine green angiography was performed according to a standard protocol used for inflammatory disorders. Systemic steroids were used for treatment. MAIN OUTCOME MEASURES: Indocyanine green angiographic findings were correlated with funduscopy, fluorescein angiography, inflammatory activity, disease stage, and response to systemic steroids. RESULTS: In newly diagnosed acute disease with exudative retinal detachments, the main features observed in all three patients were: (1) signs indicating choroidal inflammatory vasculopathy, including choriocapillaris perfusion delay in the very early angiographic phase, perivascular leakage of individual vessels in the early phase, diffusely leaking fuzzy vessels in the intermediate phase, and diffuse choroidal hyperfluorescence in the late phase; (2) hypofluorescent dark dots during the intermediate phase of angiography, either becoming isofluorescent in the late phase of the angiogram or remaining hypofluorescent, probably representing partial or full-thickness granuloma; (3) disc hyperfluorescence indicating severe papillitis; and (4) hyperfluorescent pinpoints in the area of exudative retinal detachment. Recurrences in the six patients with chronically evolving disease did not show the hyperfluorescent pinpoints. Otherwise, they showed the same features, albeit less pronounced, together with peripheral atrophic hypofluorescent lesions. In the two patients with "healed" disease for whom high-dose steroids had been initiated at an early stage, only dark hypofluorescent areas in the intermediate and late phases on the fluorescein angiogram were seen, probably representing choroidal scarring. CONCLUSIONS: Consistent ICGA findings in 10 VKH patients allowed the authors to establish a fairly precise pattern of choroidal involvement. Indocyanine green angiography was especially useful to observe the evolution of choroidal inflammatory involvement and to monitor the effect of steroid therapy.

Adolescent↗
PubMed2001

Value of high-frequency ultrasound biomicroscopy in uveitis.

PURPOSE: To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of inflammatory lesions of the iris, ciliary body, pars plana and peripheral vitreous, and in particular to determine the proportion of cases for which UBM contributed significant additional, hitherto inaccessible, information. METHODS: Charts of patients seen in the uveitis clinic at University Eye Hospital from November 1994 to September 1999 for whom a UBM investigation had been performed were analysed. UBM was performed in a standard manner, using a Humphrey UBM 840 system. The clinical relevance of the UBM findings was determined for the whole series and for the following six subgroups of patients arbitrarily established according to the type and location of pathology: hypotony, pseudophakic uveitis, iris and ciliary body pathology excluding hypotony, pars plana pathology, scleritis and Toxocara uveitis. Findings were classified as positive when they confirmed a suspected diagnosis of lesional process or when they gave essential information. Findings were classified as essential when they led to the diagnosis or when they modified therapeutic intervention. RESULTS: During the study period 111 eyes of 77 patients were included. UBM findings contributed essential information that allowed a diagnosis to be reached or that influenced treatment in 43% of cases. It yielded positive findings in 91% of cases, enabling assessment of morphological changes in the iris, ciliary body, and retroiridal and peripheral vitreous induced by intraocular inflammatory or pseudo-inflammatory disorders. Specific UBM signs, present in all patients, were identified in Toxocara uveitis. The groups of patients that benefited most from UBM examination were those with hypotony (83% essential findings) and opaque media (100% essential findings). CONCLUSION: For uveitis patients with an inflammatory process situated in the iris/ciliary body/pars plana/retroiridal vitreous areas, UBM was of great clinical value and improved the management in a significant manner.

Adolescent↗
PubMed2001

Detection of Toxoplasma gondii DNA in primary intraocular B-cell lymphoma.

Primary intraocular lymphoma, a variant of primary central nervous system lymphoma with ocular involvement, is a large B-cell non-Hodgkin's lymphoma. Some cases of primary intraocular lymphoma have been reported to be associated with microorganisms including Epstein-Barr virus (EBV) and human herpes virus-8 (HHV-8), but not parasites. We analyzed 10 cases of primary intraocular lymphoma using microdissection and PCR. Tumor and normal cells were microdissected from ocular tissue on slides and subjected to PCR for genes from Toxoplasma gondii, EBV, and HHV-8. We detected Toxoplasma gondii, not HHV-8 or EBV, DNA in the lymphoma but not in normal cells of two cases that resembled ocular toxoplasmosis clinically. We speculate that Toxoplasma gondii may play a role in some forms of primary intraocular B-cell lymphoma.

Adult↗
PubMed2000

Diclofenac drops to treat inflammation after cataract surgery.

PURPOSE: To compare the anti-inflammatory effect of topical diclofenac sodium 0.1% in a fixed combination with gentamicin 0.3% to the anti-inflammatory effect of dexamethasone phosphate 0.1% in a prospective randomized double-masked double-dummy study in patients undergoing cataract surgery. SETTING: Trial performed from June 1991 to April 1992 at the Hôpital Jules Gonin, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. METHODS: Inclusion of patients scheduled for extracapsular cataract extraction (ECCE) with implantation of an all PMMA intraocular lens (IOL). Double-masked comparison of post-operative inflammation in two randomized treatment groups: (1) fixed diclofenac sodium 0.1%/gentamicin 0.3% and vehicle drops 4X/day until day 12-14 and diclofenac sodium 0.1% 3X/day until day 28. (2) dexamethasone phosphate 0.1% drops 4X/day until postoperative day 12-14 and 3X/day until day 28 and gentamicin 0.3% drops 4X/day until day 12-14. Anterior chamber flare and cells, measured by laser flare-cell photometry, were analyzed as the primary outcomes. RESULTS: Eighty-seven patients were recruited, 45 being assigned to the diclofenac group and 42 to the dexamethasone control group. Diclofenac was significantly better than dexamethasone at controlling flare at day 3 (p< or =0.01) and day 12-14 (p< or =0.002). Mean anterior chamber cells were also significantly lower at day 12-14 (p< or =0.021) and day 28 (p< or =0.012). The commonest adverse event was transient punctate keratitis, which occurred in 15 diclofenac and 3 dexamethasone patients. CONCLUSIONS: While both treatments were effective at controlling post-operative inflammation, the diclofenac-gentamicin combination followed by diclofenac alone was significantly better at suppressing flare and cells but showed a slightly higher incidence of punctate keratitis and eye discomfort.

Aged↗
PubMed2000

[Intraocular hypotony: use of ultrasound biomicroscopy (UBM) for differential diagnosis and its schematic representation].

OBJECTIVES: To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of hypotony and in particular to determine the proportion of cases for which UBM contributed significant additional hitherto unaccessible information. PATIENTS AND METHODS: Ultrasound biomicroscopy was performed in a standard manner, using a Humphrey UBM 840 system (Humphrey Instruments, Inc., San Leandro, CA). UBM findings were analysed and the clinical relevance of UBM information was determined for the whole collective. RESULTS: Twelve patients with hypotony were examined. UBM findings contributed essential information that allowed to reach a diagnosis or that determined the therapeutic attitude in 10 of the 12 hypotonic patients. In two cases the cause of hypotony was tractional ciliary body detachment, in 5 cases it was post-inflammatory atrophy of the ciliary body, in 3 cases it was post-traumatic irido and cyclodialysis, in one case it was supraciliary and suprachoroidal effusion and in the last case it was due to uveal effusion syndrome. Based on these findings we established a schematic approach for hypotony. CONCLUSIONS: This procedure enabled us to assess the morphological changes found in patients with hypotony. In a majority of cases UBM was useful either to orient therapeutic intervention or to establish a diagnosis. On the base of our findings a schematic approach for hypotony, using UBM, was established.

Algorithms↗
PubMed2000

[Vogt-Koyanagi-Harada syndrome: importance of rapid diagnosis and therapeutic intervention].

AIM: The Vogt-Koyanagi-Harada (VKH) syndrome is characterized by a bilateral granulomatous uveitis with exudative retinal detachments associated with systemic manifestations such as meningeal signs, cutaneous signs (poliosis, alopecia and vitiligo) and dysacousis. VKH is relatively unfrequent in Europe and Switzerland. Therefore diagnosis is often reached with some delay. Our aim here was to analyze the 3 patients for whom the diagnosis was reached less than 15 days after the first signs and compare their evolution to seven patients for whom diagnosis was known one month or more after the first signs. PATIENTS AND METHODS: Retrospective and partially prospective study of patients seen at uveitis clinic in Lausanne from 1990 to 1999 for whom an ICG angiographic work-up had been performed in addition to the usual clinical and fluoresceinic work-up. The frequency of VKH in our collective was calculated; symptoms and signs, paraclinical investigations, laboratory work-up, delay from first signs to diagnosis, the management and the evolution were the criteria analyzed. In particular the patients with early diagnosis and early treatment were analyzed and compared to the rest of the collective. Diagnosis was based on the criteria of the American Uveitis Society. Between 1990 and 1999, 14 patients with the diagnosis of VKH were seen (1.2% of our collective of uveitis patients). The 10 patients having had a work-up including ICG angiography in addition to the classical work-up were included in this study. RESULTS: The diagnosis was reached in less than 2 weeks in 3 patients. In all 3 patients inflammation was controlled after treatment. Two patients with a follow-up without recurrence of respectively 36 and 54 months were considered as healed. The last case had no recurrence after nine months but still was under therapy. Whereas clinical examination and fluorescein angiography failed to show any sequels in the 2 "healed" patients, ICG angiography showed numerous zones of hypofluorescence indicating choroidal scarring. For the 7 other cases, the diagnosis was reached one month or more after the first symptoms or signs and they all evolved in the chronic recurrent fashion. ICG angiography contributed to the rapid diagnosis in 2/3 patients with early diagnosis and was an essential parameter for the choroidal follow-up in 9/10 patients. CONCLUSION: This study shows that it is essential to rapidly reach the diagnosis of VKH and treat the patients vigorously without delay. By showing choroidal lesions not seen by the clinical examination or fluorescein angiography. ICG angiography is essential for a correct work-up and follow-up of choroidal lesions in VKH. In our two "healed" patients it was the only mean to show choroidal sequellae.

Adult↗
PubMed2000

Sensitivity of indocyanine green angiography for the follow-up of active inflammatory choriocapillaropathies.

BACKGROUND: Inflammatory choriocapillaropathies (choriocapillaritis) correspond to the clinical spectrum of lesions of the fundus, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC), and other rarer entities caused by inflammatory disturbances of choriocapillaris perfusion. The aim here was to study the sensitivity of indocyanine green (ICG) angiography in investigating and following inflammatory choriocapillaropathies. PATIENTS AND METHODS: Patients with inflammatory choriocapillaropthies were included who had had a dual fluorescein and ICG angiography as well as visual field testing (Goldman or computerized perimetry) at presentation and on follow-up visits. ICG angiography was performed according to a routine angiographic protocol used for inflammatory diseases and was correlated with fundus examination, fluorescein angiography, and visual field testing. RESULTS: Three patients with MEWDS, two with APMPPE, and two with MC were included. The visual field alterations in all seven patients were well correlated with the extent of the hypofluorescent areas seen on ICG angiography, whereas they were badly correlated with fluorescein angiographic signs and their evolution. The visual field in MEWDS was particularly well correlated with the importance of peripapillary hypofluorescence seen on ICG angiography. In MC, the evolution of new lesions was well demonstrated by ICG angiography and well correlated with visual symptoms and visual fields, but was barely detected on fundus examination and by fluorescein angiography. CONCLUSIONS: ICG angiographic signs were shown to be closely correlated with visual function (visual field testing). This was not the case for either fundus examination or fluorescein angiography. ICG angiography appears as a very sensitive follow-up parameter in inflammatory choriocapillaropathies, giving morphological information on the evolution of the disease and on the response to treatment when therapy is indicated.

Adult↗
PubMed2000

Vitrectomy in the management of uveitis.

OBJECTIVE: To review the indications for vitrectomy in uveitis cases. PATIENTS AND METHODS: Charts of patients seen at the uveitis clinic of the Jules Gonin Eye Hospital from January 1993 to August 1998 and who had undergone vitrectomy were reviewed. Patients with infectious uveitis occurring within three months after intraocular cataract surgery were excluded. The types of uveitis were recorded and indications for vitrectomy were analyzed. RESULTS: A total of 630 patients were examined at the uveitis clinic. Fifty-one of these patients (51 eyes, 8.1%) were referred for vitrectomy and were included in this study. Vitrectomy was performed for three reasons: 1) to treat the complications of uveitis (90%), including vitreous opacification in 35 eyes (69%), retinal detachment in seven eyes (14%), epimacular membrane in seven eyes (14%), and dense opacification of the posterior capsule after cataract surgery in six eyes (12%)(the mean delay between uveitis and vitrectomy in this group was 8.4 years); 2) for diagnostic purposes in 19 eyes (37%); and 3) to remove confined infectious foci in 16 eyes (31%) and allow a thorough intraocular distribution of antibiotics. Visual acuity improved in 41 patients (80.4%), remained unchanged in three (5.8%), and decreased in seven (13.7%) because of secondary or persistent retinal detachment or cystoid macular edema. CONCLUSION: Vitrectomy was indicated to treat the complications of uveitis, to provide vitreous for diagnostic purposes, and to allow a better diffusion of intraocular antibiotics. Long-standing uveitis did not seem to be influenced by vitrectomy.

Adolescent↗
PubMed2000

Precise monitoring and differentiation of inflammatory events by indocyanine green (ICG) angiography in a case of recurrent posterior sarcoid uveitis.

PURPOSE: By providing information on choroidal lesions, indocyanine green (ICG) angiography is complementary to fluorescein angiography in the workup of posterior uveitis. The aim here was to illustrate practically the suitability of performing dual fluorescein/ICG angiograms in a demonstrative case of recurrent presumed posterior sarcoid uveitis. METHODS: Sequential dual fluorescein/ICG angiograms were performed for the workup and follow-up of a case of recurrent presumed sarcoid uveitis. RESULTS: Dual fluorescein and ICG angiograms performed during the first recrudescence of inflammation showed mainly retinal involvement with cystoid macular edema, diffuse posterior pole retinal hyperfluorescence, and papillitis, whereas the second recurrence after tapering oral corticosteroid therapy showed new choroidal lesions of the posterior pole in the absence of significant retinal involvement. CONCLUSIONS: Dual fluorescein/ICG angiography clearly allowed the differentiation of two different inflammatory events, one involving the retina and the other involving the choroid, at the origin of similar clinical manifestations.

Choroid↗
PubMed1999

Posterior sub-Tenon's steroid injections for the treatment of posterior ocular inflammation: indications, efficacy and side effects.

PURPOSE: Posterior sub-Tenon's steroid injections (PSTSI) are a standard drug delivery method used for the treatment of chronic uveitis of the posterior segment. The aim of this study was to analyse the indications, efficacy and complications of PSTSI in the treatment of chronic uveitis. METHODS: During the period 1990-1994, 53 (9.5%) of 558 patients (58 eyes) followed up in the uveitis clinic received a total of 162 PSTSI of triamcinolone acetonide 40 mg in the superior quadrants. Indications for treatment were vision inferior or equal to 0.7 and/or intolerable visual disturbance. Only patients in whom PSTSI were the only treatment parameter changed were analysed. Among the main parameters analysed were visual acuity, aqueous laser flare photometry, intraocular pressure (IOP) and complications. RESULTS: Anatomical location of uveitis was as follows: anterior HLA-B27-related uveitis with CME (1 patient/1 eye), intermediate uveitis (28/32), posterior uveitis (10/10) and panuveitis (14/15). Mean duration of follow-up was 448+/-57 days. Visual acuity improved significantly from 0.40+/-0.03 to 0.79+/-0.07, with 59.4% of eyes having a gain of 2-5 Snellen lines and 18.7% a gain of >5 lines. Mean aqueous flare photometry decreased significantly from 29.6+/-3.5 to 13.6+/-2.2 photons/ms. Mean IOP increased significantly from 13.6+/-0.5 to 18.5+/-0.8 mm Hg with a rise of pressure >8 mm Hg in 23 cases (36%), transient in 16 cases, but chronic in 6 cases, needing filtering surgery. Partial superior ptosis was seen in two cases and cataract progressed in seven cases. CONCLUSION: PSTSI are very effective in restoring visual acuity in chronic uveitis of the posterior segment, without systemic complications, but at the expense of intraocular hypertension, a complication that was found more frequently than expected.

Adolescent↗
PubMed1999

Indocyanine green angiographic features in tuberculous chorioretinitis.

PURPOSE: To determine choroidal involvement in presumed tuberculous posterior uveitis by examining indocyanine green angiographic features. METHODS: Indocyanine green angiography was performed according to a standard uveitis angiographic protocol in eight consecutive patients (15 eyes) with presumed posterior tuberculous uveitis. RESULTS: In 100% of the 15 examined eyes, indocyanine green angiography disclosed choroidal lesions that were subclinical, not detected by fundus examination or fluorescein angiography, in six (40%) of 15 eyes. Findings were classified into four main angiographic signs: (1) irregularly distributed, hypofluorescent areas in the early and intermediate phases of angiography that either became isofluorescent (type 1 hypofluorescence) or remained hypofluorescent (type 2 hypofluorescence) in the late phase; (2) numerous, small, focal, hyperfluorescent spots; (3) choroidal vessels that appeared fuzzy in the intermediate phase because of leakage, leading in the late phase to (4) diffuse choroidal hyperfluorescence. Type 1 hypofluorescent lesions, fuzzy choroidal vessels, and diffuse choroidal hyperfluorescence tended to regress after the initiation of antituberculous and corticosteroid treatment. Focal hyperfluorescence tended to be associated with longstanding disease. CONCLUSIONS: Indocyanine green angiography was useful in assessing and quantifying the as yet unknown extent of choroidal involvement in tuberculous posterior uveitis. Its characteristic appearance may be a valuable contribution to the diagnosis and monitoring of treatment response.

Chorioretinitis↗
PubMed1999

Ultrasound biomicroscopy in peripheral retinovitreal toxocariasis.

PURPOSE: To report ultrasound biomicroscopic features in peripheral retinovitreal Toxocara uveitis. METHODS: Three patients with unilateral vitreitis suspected to be caused by peripheral toxocariasis were referred for ultrasound biomicroscopic examination of the peripheral retina, pars plana, and adjacent vitreous. RESULTS: In two of the three patients, characteristic pseudocystic transformation of the peripheral vitreous was seen. In both patients, Toxocara serology was positive and eosinophilia was present. In the third patient, no pseudocystic transformation of the peripheral vitreous was seen; however, there was the dense thickening adjacent to the pars plana usually seen by ultrasound biomicroscopy in pars planitis and corresponding to clinically visible snowbanks. The third patient had a negative Toxocara serology and later developed bilateral intermediate uveitis of the pars planitis type. In none of 48 patients with diverse inflammatory conditions of the retroiridal space that were examined by ultrasound biomicroscopy were the characteristic Toxocara-associated pseudocystic images seen. CONCLUSIONS: Pseudocystic transformation of the peripheral vitreous appears to be a rather specific and sensitive ultrasound biomicroscopic sign in patients with presumed peripheral toxocariasis that will likely aid diagnosis in difficult cases.

Adult↗
PubMed1999

Indocyanine green angiographic features in ocular sarcoidosis.

OBJECTIVE: To determine indocyanine green (ICG) angiographic features and evaluate the extent of choroidal involvement in proven cases of posterior ocular sarcoidosis. DESIGN: Nonrandomized controlled trial. PARTICIPANTS: Nineteen patients (14 females, 5 males; average age, 56 +/- 4 years) with clinically typical posterior sarcoidosis (biopsy-proven in 6 cases and fulfilling the other diagnostic criteria in 13 cases) participated, with 10 control subjects (average age, 48 +/- 7 years). Criteria for the diagnosis of sarcoidosis were a positive biopsy result or the presence of at least three of the following four criteria: elevated serum angiotensin-converting enzyme, elevated lysozyme, cutaneous anergy, and hilar lymph node enlargement. INTERVENTION: Indocyanine green angiography was performed according to a standard angiographic protocol used in inflammatory disorders. MAIN OUTCOME MEASURES: Indocyanine green angiographic features and proportion of choroidal inflammatory involvement were measured. RESULTS: Indocyanine green angiographic features could be classified into four main patterns. The first pattern is hypofluorescent choroidal lesions in the early and intermediate phases, irregularly distributed, invisible on funduscopy or fluorescein angiography, and localized in the midperiphery (63% of patients), in the macula (11%) or in both regions (26%) with an average dot diameter of 0.31 +/- 0.03 disc diameters. These lesions either became isofluorescent in the late phase of the angiogram (Type 1, present in all patients) or remained hypofluorescent (Type 2, present in 84% of patients). The second pattern is focal hyperfluorescent pinpoints visible in the intermediate and late phases (in 89% of patients). The third pattern is fuzzy choroidal vessels with leakage in the intermediate phase of the angiogram, and the fourth pattern is diffuse late zonal choroidal hyperfluorescence with staining in the late phase of the angiogram, both features being present in all patients. CONCLUSIONS: Indocyanine green angiography allowed the authors to assess and quantify the hitherto unknown extent of choroidal involvement in ocular sarcoidosis. Furthermore, characteristic ICG findings might represent an additional valuable tool for diagnosing and monitoring this disease.

Choroid↗