Abstract
Purpose: To investigate the causes of multifocal granular hyperfluorescence at the macula on fluorescein angiography (FA) in Japanese patients. Methods: I retrospectively studied 1,457 consecutive Japanese patients (1,457 eyes) who underwent digital simultaneous FA and indocyanine green angiography (ICGA). Results: One hundred forty-seven of the 1,457 eyes had multifocal granular hyperfluorescence on FA images. Of the 147 eyes, 94 (64%) eyes had polypoidal choroidal vasculopathy (PCV); 25 (17%) eyes had either recurrent or chronic central serous chorioretinopathy (CSC); 19 (13%) eyes had occult choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD); and three (2%) eyes had multiple evanescent white-dot syndrome. No diagnosis was established in 6 (4%) eyes because of the difficulty differentiating chronic CSC, PCV, and occult CNV. Conclusions: The current results showed that PCV, occult CNV, and chronic CSC are the main causes of multifocal granular hyperfluorescence on FA. Thus, clinicians first should consider such disorders when examining patients with scattered lesions with pigment epithelial degeneration on ophthalmoscopy and multifocal granular hyperfluorescence on FA.
Highlights
Fluorescein angiography (FA) is an imaging examination that highlights the retinal and choroidal circulation and useful in the diagnosis of fundus disorders
In eyes with occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), retinal pigment epithelium (RPE) decompensation can develop with window defects seen on FA images, the multifocal granular hyperfluorescent lesions are not as common [6,7]
Of the 147 eyes, 94 (64%) eyes had Polypoidal choroidal vasculopathy (PCV); 25 (17%) eyes had either recurrent or chronic central serous chorioretinopathy (CSC); 19 (13%) eyes had occult CNV associated with AMD; and three (2%) eyes had multiple evanescent white-dot syndrome
Summary
Fluorescein angiography (FA) is an imaging examination that highlights the retinal and choroidal circulation and useful in the diagnosis of fundus disorders. Multifocal granular hyperfluorescence seen on FA indicates diffuse RPE damage [1]. Multiple areas of diffuse RPE decompensation can evolve, resulting in gradual leakage through the posterior blood-retinal barrier and an indistinct zone of staining or oozing seen on FA images [1]. In eyes with occult choroidal neovascularization (CNV) secondary to (age-related macular degeneration) AMD, RPE decompensation can develop with window defects seen on FA images, the multifocal granular hyperfluorescent lesions are not as common [6,7]. Because PCV has a chronic natural history, diffuse retinal pigment epithelium (RPE) damage may develop in these eyes [8,9,10,11,12]. Multifocal granular hyperfluorescence occasionally is seen on FA images in eyes with PCV. The causes of multifocal granular hyperfluorescence on FA at the macula of Japanese patients were investigated and the clinical findings among the causes were compared to evaluate the essential elements in a differential diagnosis
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