International Ophthalmology

, Volume 6, Issue 2, pp 125–138 | Cite as

Fluorescein angiography of the choroid in health and disease

  • J. J. De Laey
Article

Abstract

Fluorescein angiography of the normal fundus reveals the segmental nature of the choroidal vascular bed. Despite the presence of anatomically demonstrable anastomoses, a segmental distribution is present in vivo up to the choriocapillaris level. Choroidal vascular diseases manifest by localized of diffuse delayed or incomplete filling of the choroid and by the involvement of the overlying retinal pigment epithelium. In the acute phase of choroidal arterial occlusive disease, ophthalmoscopy reveals localized or diffuse edema. Fluorescein angiography of such cases initially shows a delayed perfusion of the involved area followed later on by fluorescein leakage. This late diffusion of the dye is probably related to alterations of the retinal pigment epithelial barrier. The extent of the lesion after resolution of the edema mainly depends on the site and the extent of the occlusion, on the development of collaterals and possibly on the involvement of the choroidal venous circulation. Ophthalmoscopy and fluorescein angiography will reveal localized or diffuse pigmentary changes, sometimes of quite characteristic aspect. This may be associated with local destruction of the choriocapillaris, although normalization of choroidal blood flow may also be observed. Chronic choroidal vascular insufficiency is a possible cause for choroidal sclerosis. Chronic choroidal ischemia is also a possible explanation for peripheral pigmentary changes seen in the elderly.

Keywords

choroid fluorescein angiography acute and chronic choroidal vascular insufficiency 

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References

  1. 1.
    Amalric, P. Examen clinique des artères ciliaires courtes postérieures. Note préliminaire. Bull. Soc. Ophtal. Fr., 63: 1–10 (1963).Google Scholar
  2. 2.
    Amalric, P. Acute choroidal ischaemia. Trans. Ophthal. Soc. U.K., 91: 305–322 (1971).Google Scholar
  3. 3.
    Amalric, P. Triangular shaped choroidal alterations. Mod. Probl. Ophthal., 9: 68–77 (1971).Google Scholar
  4. 4.
    Anderson, D.R. & E.B. Davis. Retina and optic nerve after posterior ciliary artery occlusion. Arch. Ophthalmol., 92: 422–426 (1974).Google Scholar
  5. 5.
    Archer, D., A.E. Krill & F.W. Newell. Fluorescein studies of choroidal circulation. Am. J. Ophthalmol., 69: 543–554 (1970).Google Scholar
  6. 6.
    Azar, P., R.S. Smith & M.H. Greenberg. Ocular findings in disseminated intravascular coagulation. Am. J. Ophthalmol., 78: 493–496 (1974).Google Scholar
  7. 7.
    Blumenthal, M., M. Best, M. Galin & H. Toyofuku. Peripapillary choroidal circulation in glaucoma. Arch. Ophthalmol., 86: 31–38 (1971).Google Scholar
  8. 8.
    Cogan, D.G. Ocular involvement in disseminated intravascular coagulopathy. Arch. Ophthalmol., 93: 1–8 (1975).Google Scholar
  9. 9.
    Condon, P.I., G.R. Serjeant & H. Ikeda. Unusual chorioretinal degeneration in sickle cell disease. Br. J. Ophthalmol., 57: 81–88 (1973).Google Scholar
  10. 10.
    Correia, J.C. Vascularisation de la choroide. Acta Anatom., 31: 238–244 (1957).Google Scholar
  11. 11.
    Coscas, G., A. Gaudric, P. Dhermy, J.P. Vernant & C. Cordonnier. Obstruction choriocapillaire au cours de la maladie de Moschowitcz. A propos de 2 cas. J. Fr. Ophtalmol., 4: 101–111 (1981).Google Scholar
  12. 12.
    De Laey, J.J. Fluoro-angiographic study of the choroid in man. Doc. Ophthalmol., 45: 1–217 (1978).Google Scholar
  13. 13.
    Delori, F., I. Ben Sira & C. Trempe. Fluorescein angiography with an optimized filter combination. Am. J. Ophthalmol., 82: 559–566 (1976).Google Scholar
  14. 14.
    Ducournau, D. Anatomie de la Vascularisation choroidienne. In Ducournau D., Gaudric A., Grange J.D., Hache J.C., Soubrane G. & Turut P.: La vascularisation choroidienne. Bull Soc. Ophthal. Fr., numéro spécial, 7–36 (1981).Google Scholar
  15. 15.
    Elschnig, A. Die diagnostische und prognostische Bedeutung der Netzhauterkrankungen bei Nephritis. Wien Med. Wochenschr., 54: 446–450 (1904).Google Scholar
  16. 16.
    Evans, P.Y., K. Shimizu, S. Limaye, E. Deglin & J. Wruck. Fluorescein cineangiography of the optic nerve head. Trans. Amer. Acad. Ophthalmol. Otolaryngol., 77: 260–273 (1973).Google Scholar
  17. 17.
    Farkas, T.G., V. Silvester & D. Archer. The choroidopathy of progressive systemic sclerosis (scleroderma). Am. J. Ophthalmol., 74: 875–886 (1972).Google Scholar
  18. 18.
    Fastenberg, D.M., C.L. Fetkenhour, E. Choromokos & D.E. Shoch. Choroidal vascular changes in toxemia of pregnancy. Am. J. Ophthalmol., 89: 362–368 (1980).Google Scholar
  19. 19.
    Flower, R.W. Choroidal fluorescent dye filling patterns. A comparison of high speed indocyanin green and fluorescein angiograms. Int. Ophthalmol., 2: 143–149 (1980).Google Scholar
  20. 20.
    Foulds, W.S., W.R. Lee & W.O.G. Taylor. Clinical and pathological aspects of choroidal ischemia. Trans. Ophthal. Soc. U.K., 91: 323–343 (1971).Google Scholar
  21. 21.
    Friedman, E., T.R. Smith, T. Kuwabara & C.K. Beyer. Choroidal vascular patterns in hypertension. Arch. Ophthalmol., 71: 842–850 (1964).Google Scholar
  22. 22.
    Galinos, S.O., G.K. Asdourian, M.B. Woolf, M.F. Goldberg & B.J. Busse. Choroido-vitreal neovascularization after argon laser photocoagulation. Arch. Ophthalmol., 93: 524–530 (1975).Google Scholar
  23. 23.
    Gaudric, A. Les occlusions choroidiennes vasculaires aigues. In Ducournau D., Gaudric A., Grange J.D., Hache J.C., Soubrane & Turut P., La vascularisation choroidienne. Bull. Soc. Ophtal. Fr., numéro spécial: 67–133 (1981).Google Scholar
  24. 24.
    Gaudric, A., M. Binaghi & G. Coscas. Occlusion choriocapillaire aigue et taches d'Elschnig au cours d'une toxémie gravidique. J. Fr. Ophthalmol., 4: 223–229 (1981).Google Scholar
  25. 25.
    Gitter, K.A., B.P. Houser, L.K. Sarin & J. Justice, Jr. Toxemia of pregnancy. An angiographic interpretation of fundus changes. Arch. Ophthalmol., 80: 449–454 (1968).Google Scholar
  26. 26.
    Goldbaum, M.H., S.O. Galinos, D. Apple, G.K. Asdourian, K. Napgal, L. Jampol, M.B. Woolf & B. Busse. Acute choroidal ischemia as a complication of photocoagulation. Arch. Ophthalmol., 94: 1025–1035 (1976).Google Scholar
  27. 27.
    Hayreh, S.S. Optic changes in glaucoma. Br. J. Ophthalmol., 56: 175–185 (1972).Google Scholar
  28. 28.
    Hayreh, S.S. Anterior ischaemic optic neuropathy. II. Fundus on ophthalmoscopy and fluorescein angiography. Br. J. Ophthalmol., 58: 964–980 (1974).Google Scholar
  29. 29.
    Hayreh, S.S. Recent advances in fluorescein fundus angiography. Br. J. Ophthalmol., 58: 391–412 (1974).Google Scholar
  30. 30.
    Hayreh, S.S. The choriocapillaris. Albrecht v. Graefe's Arch. Klin. Ophthalmol., 192: 165–179 (1974).Google Scholar
  31. 31.
    Hayreh, S.S. Anterior ischemic optic neuropathy. Springer Verlag, Berlin, Heidelberg, New York, 1975.Google Scholar
  32. 32.
    Hayreh, S.S. & J.A.B. Baines. Occlusion of the posterior ciliary artery. I. Effects on choroidal circulation. Br. J. Ophthalmol., 56: 719–735 (1972).Google Scholar
  33. 33.
    Hayreh, S.S. & J.A.B. Baines. Occlusion of the posterior ciliary artery. II. Chorioretinal lesions. Br. J. Ophthalmol., 56: 736–753 (1972).Google Scholar
  34. 34.
    Hayreh, S.S. & J.A.B. Baines. Occlusion of the posterior ciliary artery. III. Effect on the optic nerve head. Br. J. Ophthalmol., 56: 754–764 (1972).Google Scholar
  35. 35.
    Hayreh, S.S. & J.A.B. Baines. Occlusion of the vortex veins. An experimental study. Br. J. Ophthalmol., 57: 217–233 (1973).Google Scholar
  36. 36.
    Hyvarinen L., A.E. Maumenee, T. George & G.W. Weinstein. Fluorescein angiography of the choriocapillaris. Am. J. Ophthalmol., 67: 653–666 (1969).Google Scholar
  37. 37.
    Jampol, L.M., M. Lahau, D.M. Albert & J. Craft. Ocular clinical findings and basement membrane changes in Goodpasture's syndrome. Am. J. Ophthalmol., 79: 452–463 (1975).Google Scholar
  38. 38.
    Kalvin, N.H., D.I. Hamasaki & J.D.M. Gass. Experimental glaucoma in monkeys. II. Studies of intraocular vascularity during glaucoma. Arch. Ophthalmol., 76: 94–103 (1966).Google Scholar
  39. 39.
    Klien, B.A. Ischemic infarcts of the choroid (Elschnig spots). A cause of retinal separation in hypertensive disease with renal insufficiency. A clinical and histopathologic study. Am. J. Ophthalmol., 66: 1069–1074 (1968).Google Scholar
  40. 40.
    Krey, H.F. Segmental vascular patterns of the choriocapillaris. Am. J. Ophthalmol., 80: 198–202 (1975).Google Scholar
  41. 41.
    Mabie, W.C. & R.R. Ober. Fluorescein angiography in toxaemia of pregnancy. Br. J. Ophthalmol., 64: 666–671 (1980).Google Scholar
  42. 42.
    McLeod, D., E.O. Oji, E.M. Kohner & J. Marshall. Fundus signs in temporal arteritis. Br. J. Ophthalmol., 62: 591–594 (1978).Google Scholar
  43. 43.
    Morse, P.H. Elschnig spots and hypertensive choroidopathy. Am. J. Ophthalmol., 66: 844–851 (1968).Google Scholar
  44. 44.
    Okun, E. Gross and microscopic pathology in autopsy eyes. Part II. Peripheral chorioretinal atrophy. Am. J. Ophthalmol., 50: 574–583 (1960).Google Scholar
  45. 45.
    Oliver, M. & D. Uchenik. Bilateral exsudative retinal detachment in eclampsia without hypertensive retinopathy. Am. J. Ophthalmol., 90: 792–796 (1980).Google Scholar
  46. 46.
    Oosterhuis, J.A. & C.H.O.M. von Winning. Naevus of the choroid. Ophthalmologica, 178: 156–165 (1979).Google Scholar
  47. 47.
    Percival, S.P.B. Ocular findings in thrombotic thrombocytopenic purpura (Moschowitz's disease). Br. J. Ophthalmol., 54: 73–78 (1970).Google Scholar
  48. 48.
    Perry, H.D., R.G. Hatfield & M.O.M. Tso. Fluorescein pattern of the choriocapillaris in the neonatal rhesus monkey. Am. J. Ophthalmol., 84: 197–204 (1977).Google Scholar
  49. 49.
    Raitta, C. & T. Sarmela. Fluorescein angiography of the optic disc and the peripapillary area in chronic glaucoma. Acta Ophthalmol., 48: 303–308 (1970).Google Scholar
  50. 50.
    Ring, H.G. & T. Fujino. Observation in the anatomy and pathology of the choroidal vasculature. Arch. Ophthalmol., 78: 431–444 (1967).Google Scholar
  51. 51.
    Sarks, S.H. Senile choroidal sclerosis. Br. J. Ophthalmol., 57: 98–109 (1973).Google Scholar
  52. 52.
    Shimizu, K. & K. Ujie. Structure of ocular vessels. Ed. Igaku Shoin, Ltd., Tokyo, pp. 50–92 (1978).Google Scholar
  53. 53.
    Shimizu, K., K. Yokochi & T. Okano. Fluorescein angiography of the choroid. Jap. J. Ophthalmol., 18: 97–108 (1974).Google Scholar
  54. 54.
    Stefani, F.H., E. Brandt & K. Pielsticker. Periarteritis nodosa and thrombotic thrombocytopenid purpura with serous retinal detachment in siblings. Br. J. Ophthalmol., 62: 402–407 (1978).Google Scholar
  55. 55.
    Stern, W.H. & J.T. Ernest. Microsphere occlusion of the choriocapillaris in rhesus monkeys. Am. J. Ophthalmol., 78: 434–448 (1974).Google Scholar
  56. 56.
    Swietliczko, I. & J.H. David. Fluorescein angiography in experimental ocular hypertension. Am. J. Ophthalmol., 70: 351–363 (1970).Google Scholar
  57. 57.
    Torczynski, E. & M.O.M. Tso. The architecture of the choriocapillaris at the posterior pole. Am. J. Ophthalmol., 81: 428–440(1976).Google Scholar
  58. 58.
    Vannas, S.F. Microcirculatory disturbances of occlusive diseases of the eye. In: Shimizu K. Ed., Fluorescein angiography. Ed. Igaku Shoin Ltd., Tokyo. pp. 103–114 (1974).Google Scholar
  59. 59.
    Wybar, K.C. Vascular anatomy of the choroid in relation to selective localization of ocular disease. Br. J. Ophthalmol., 38: 513–527 (1954).Google Scholar

Copyright information

© Dr W. Junk Publishers 1983

Authors and Affiliations

  • J. J. De Laey
    • 1
  1. 1.Department of OpthalmologyUniversity HospitalGhentBelgium

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