Indocyanine green videoangiography of malignant melanomas of the choroid using the scanning laser ophthalmoscope.

The diagnostic value of fluorescein angiography (FA) in the evaluation of small suspected choroidal melanomas is limited. Indocyanine green videoangiography (ICGV) has overcome some of the problems of FA in the imaging of normal and abnormal choroidal vessels. This study was performed to reveal the role of ICGV in the detection of the intrinsic tumor vasculature of choroidal malignant melanomas. A total of 24 patients with posterior-segment malignant melanoma underwent FA and ICGV using the scanning laser ophthalmoscope. All patients were grouped into 1 of 2 categories, depending on the tumor elevation: group I 10 patients with lesions elevated to < 4 mm, and group II 14 patients with lesions measuring > 4 and < 8 mm in height. On early frames of the ICGV the borders of the tumors were better demarcated from the background and the tumors appeared larger in the basal dimension than with FA or clinical examination. ICGV was superior to standard FA in imaging intrinsic tumor vasculature. Abnormal vasculature features included different caliber size, tortuosities, corkscrew loops, irregular ramifications, and irregular staining of the vessel walls. These intrinsic tumor vessels were identified in 6 of 10 patients from group I and in 12 of 14 patients from group II. ICGV appears to add some information in the diagnosis and documentation of tumor growth. It may allow detection of pathologic tumor vessels that cannot be detected by standard FA. The borders of the tumor are better demarcated against the background by ICGV than by FA or clinical examination.