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April 2001

Fluorescein Angiograms Do Not Support Choroidal Ischemia

Arch Ophthalmol. 2001;119(4):622-623. doi:

In reply

We thank Dr James L. Kinyoun for his constructive comments concerning our article.1 The ocular symptoms that the patient complained of initially included blurred vision in both eyes and paracentral scotomas, particularly in his right eye. The published fundus photograph of the right eye was taken at this initial visit. Unfortunately, no fluorescein or indocyanine green angiogram was obtained at that time. We agree with Dr Kinyoun that patchy choroidal filling may occur and must be differentiated from choroidal ischemia. To demonstrate that choroidal filling defects persisted longer than usually seen with irregular filling patterns, we show an arteriovenous phase (17.3 seconds) of a fluorescein angiogram (Figure 1A) that was obtained 2 months later, at the time of visual decrease. The late phase (12.9 minutes) clearly showed leakage of large retinal veins (Figure 1B). We intended to publish the follow-up fluorescein angiogram; however, the number of images we were allowed to publish was restricted. As Dr Kinyoun correctly noticed, the angiograms published in our original article were from 2 different dates. Figure 2B in the original article was obtained 7 months after the initial examination. Later phases of this angiogram also demonstrated absence of choroidal perfusion.