Quantifying changes in corneal neovascularization using fluorescein and indocyanine green angiography

Am J Ophthalmol. 2012 Nov;154(5):850-858.e2. doi: 10.1016/j.ajo.2012.04.021. Epub 2012 Jul 26.


Purpose: To quantify changes in corneal neovascularization in patients with active keratitis after treatment using color imaging, fluorescein angiography (FA), and indocyanine green angiography (ICGA).

Design: Prospective, interventional case series.

Methods: Twelve consecutive patients were studied. A comparison of corneal neovascularization parameters was undertaken before and after resolution of the keratitis. A slit-lamp digital camera acquired images of the neovascularization using color imaging, FA, and ICGA. The best-quality images were selected using a grading system, and the neovascular regions of interest were analyzed using automated in-house software. The parameters of analysis were vessel area, diameter, tortuosity, and FA dye leakage.

Results: There was a significant reduction in the area of neovascularization after treatment on color imaging (0.78 mm(2); P < .05), FA (2.33 mm(2); P < .01), and ICGA (2.07 mm(2); P < .01). There was also a significant reduction in mean vessel diameter across the region of interest for each patient, more marked on FA (42.74 to 32.52 μm; P < .01) and ICGA (44.77 to 33.29 μm; P < .01) than on color imaging (29.10 to 25.17 μm; P < .01). A significant change in vessel tortuosity was not observed. There was a significant increase in FA dye leakage time (12.41 seconds; P < .05) after treatment.

Conclusions: We demonstrate application of an objective method for analyzing changes in corneal neovascularization. The excellent vessel delineation with ICGA even in the presence of stromal scars makes it an ideal agent for measurement of vessel parameters. FA is useful at detecting vessel leakage, and the time to leakage provides a possible measure of vessel staging.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Coloring Agents*
  • Cornea / blood supply
  • Corneal Neovascularization / diagnosis*
  • Corneal Neovascularization / drug therapy
  • Corneal Neovascularization / etiology
  • Corneal Ulcer / microbiology
  • Eye Infections, Bacterial / etiology
  • Female
  • Fluorescein Angiography*
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Indocyanine Green*
  • Keratitis, Herpetic / etiology
  • Keratoplasty, Penetrating / adverse effects
  • Male
  • Middle Aged
  • Prospective Studies


  • Coloring Agents
  • Indocyanine Green