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PubMed

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BACKGROUND: While performing indocyanine-green (ICG) videoangiograms with the Rodenstock scanning laser ophthalmoscope (SLO), we got more and more aware of visible choroidal pulsation mainly during the inflow of ICG into the eye. We wanted to learn more about the frequency and the different forms of this phenomenon. MATERIAL AND METHODS: We examined 187 consecutive ICG angiographies retrospectively, which were performed with a Rodenstock SLO and stored by videotape. Most patients suffered from age-related macular degeneration and had a mean age of about 70 years. We defined 4 groups of different pulsatile dye inflow in the choroid, namely (group 1) the diffuse form, involving the whole macular region; (group 2) the local form, involving an area smaller than the fovea. In group 3 (mixed form) we found the pulsatile inflow diffuse initially, later on remained a local pulsation. In group 4 (special form) we noticed a localized pulsation of a longer duration (10-15 seconds) and of a special type, namely back and forth movements of dye in one or a few choroidal veins. In addition, we examined the presence of pulsation in the central retinal vein. RESULTS: In 173 of 187 angiograms we could examine the choroidal inflow in the macular region. We found in 94 of these 173 angiograms (or in 54%) choroidal pulsation. 84% of all cases were in group 1, 2 and 3. This probably physiological pulsation occurred mostly in the first few seconds after the inflow of the dye. After about 5 seconds it was normally not visible any more. In our group 4 we collected 16 out of 94 angiograms (or 17%). We could not find a correlation between the presence of a pulsation in the central vein and in the choroid. CONCLUSIONS: Choroidal pulsatile inflow of ICG is a frequent (most probably physiological) phenomenon. The localized pulsation found in several older patients with back and forth movements of dye in one or a few veins may be abnormal; it reflects phasic pressure changes in choroidal veins of low flow. We do not know yet if this phenomenon is of any diagnostic value. However, more studies of these interesting dynamic processes seem to be warranted.