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Scoring of dual fluorescein and ICG inflammatory angiographic signs for the grading of posterior segment inflammation (dual fluorescein and ICG angiographic scoring system for uveitis)

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Abstract

Purpose To propose a semiquantitative dual fluorescein angiography (FA) and indocyanine green angiography (ICGA) scoring system for uveitis that would assist in the follow-up of disease progression and monitoring response to treatment. Methods The scoring system was based on the FA scoring systems, the standardized ICGA protocol, and schematic interpretation of ICGA findings in posterior uveitis that have been previously published. We assigned scores to the fluorescein and ICG angiographic signs that represent ongoing inflammatory process in the posterior segment. We rated each angiographic sign according to the impact it has on our appreciation of active intraocular inflammation. In order to permit direct comparison between FA and ICGA, we multiplied the total ICGA score by a coefficient of 2 to adjust to the total score of FA. Results A total maximum score of 40 was assigned to the FA signs, including optic disc hyperfluorescence, macular edema, retinal vascular staining and/or leakage, capillary leakage, retinal capillary nonperfusion, neovascularization of the optic disc, neovascularization elsewhere, pinpoint leaks, and retinal staining and/or subretinal pooling. A total maximum score of 20 was assigned to the ICGA signs, including early stromal vessel hyperfluorescence, choroidal vasculitis, dark dots or areas (excluding atrophy), and optic disc hyperfluorescence. Conclusion The combined fluorescein and ICG angiographic scoring system proposed herein may help estimate the magnitude of retinal versus choroidal inflammation, monitor disease progression and response to treatment, and provide comparable data for clinical studies. The applicability of the proposed system needs to be tested in clinical settings, and intra- and interobserver variations need to be determined.

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Authors and Affiliations

  1. Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey

    Ilknur Tugal-Tutkun

  2. Inflammatory Eye Diseases, Center for Specialized Ophthalmic Care, Lausanne, Switzerland

    Carl P. Herbort

  3. Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia

    Moncef Khairallah

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  1. Ilknur Tugal-Tutkun
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  2. Carl P. Herbort
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The Angiography Scoring for Uveitis Working Group (ASUWOG)

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Correspondence to Ilknur Tugal-Tutkun.

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The Angiography Scoring for Uveitis Working Group (ASUWOG)—Pia Allegri (Genova, Italy), Barbara Biziorek (Lublin, Poland), Bahram Bodaghi (Paris, France), Nadia Bouchenaki (Lausanne, Switzerland), Luca Cimino (Reggio Emilia, Italy), Christine Fardeau (Paris, France), Amod Gupta (Chandigarh, India), Vishali Gupta (Chandigarh, India), Philippe Kestelyn (Ghent, Belgium), Alessandro Mantovani (Como, Italy), Manabu Mochizuki (Tokyo, Japan), Piergiorgio Neri (Ancona, Italy), Carlos Pavesio (London, UK) (in alphabetical order).

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Tugal-Tutkun, I., Herbort, C.P., Khairallah, M. et al. Scoring of dual fluorescein and ICG inflammatory angiographic signs for the grading of posterior segment inflammation (dual fluorescein and ICG angiographic scoring system for uveitis). Int Ophthalmol 30, 539–552 (2010). https://doi.org/10.1007/s10792-008-9263-x

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