Purpose: In the mid-late life, basal laminar drusen can be associated with vitelliform macular degeneration and choroidal neovascularization. The differential diagnosis between these two clinical entities is not always easy with fluorescein angiography. The aim of this case report is to describe the indocyanine green angiographic features of basal laminar drusen and pseudo-vitelliform material and to evaluate the role of ICG angiography in differentiating new choroidal vessels from vitelliform macular degeneration.
Patients and methods: Six patients (12 eyes) with central visual loss and metamorphopsia underwent a biomicroscopic examination. Diagnosis was basal laminar drusen and bilateral vitelliform macular degeneration. Fluorescein and indocyanine green angiographies were performed and the results were compared.
Results: In all eyes, basal laminar drusen were hyperfluorescent with both angiographies. On fluorescein angiography, the macular material was hypofluorescent early, but gradual staining occurred from the borders in the late phase. In 8 out of the 12 eyes, fluorescein angiographic characteristics of the macular lesions could not provide clues to differential diagnostic between new choroidal vessels and vitelliform material. On indocyanine green angiography, in 8 eyes the material remained intensely hypofluorescent during the whole sequence. In 4 eyes, indocyanine green angiography allowed the identification of hyperfluorescent well-defined new choroidal vessels.
Conclusions: Indocyanine green angiography allows the visualization of basal laminar drusen and can easily differentiate choroidal neovascularization from acquired vitelliform degeneration.