Indocyanine green and fluorescein angiography in nonarteritic anterior ischemic optic neuropathy

Purpose: To assess the value of indocyanine green angiography (ICGA) for demonstrating choroidal vascular abnormalities in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods: The authors compared the ICGA and fluorescein fundus angiography characteristics of peripapillary circulation in 11 patients with acute NAION. There were 7 men and 4 women; the age range for the patients was 36 years to 72 years (mean +/- SD, 47.7 +/- 10.76 years). The angiographic factors considered significant were delay of peripapillary choroidal filling in the vertical watershed zone, leakage from the optic disk, and absolute filling defects on the disk. The authors compared the incidence of a vertical peripapillary watershed zone in the eyes of the 11 patients with that in the normal eyes of 50 controls (age range, 44-79 years) who had unilateral age-related macular degeneration. Results: Indocyanine green angiography revealed a peripapillary watershed zone in 8 of 11 patient eyes and 23 of 50 control eyes. There was no statistical difference in the number of eyes affected in each group (chi(2) = 0.53; P = 0.47). Fluorescein fundus angiography showed leakage from the disk in 10 of 11 patients, whereas ICGA highlighted this problem in only 7 of the patients. The choroidal filling time of the watershed zones was significantly longer with ICGA (t = 3.13; P = 0.011). Conclusion: Although ICGA allows better visualization of the choroidal watershed zones associated with NAION, it did not reveal any significantly different incidence of vertical choroidal watershed zone encompassing the optic disk for patients with NAION and controls. Fluorescein fundus angiography better visualized leakage from the disk in the patient group. These findings indicate that ICGA offers no significant advantage in terms of clinical diagnosis and management of NAION.