VERDYE™ Approved Indications Verdye™ (Indocyanine Green, ICG) in Ophthalmic Angiography
Part of a multimodal pathway
Visualising the choroidal circulation in ophthalmic imaging
Indocyanine green angiography (ICGA) is an established imaging technique used to evaluate the choroidal circulation. Its near-infrared fluorescence and high level of plasma-protein binding support visualisation of deeper choroidal vessels, including where pigment, blood or fluid may obscure detail with shorter-wavelength imaging.
In contemporary ophthalmology, ICGA is often used within a multimodal pathway. It contributes information that cannot always be inferred reliably from colour fundus photography, fundus autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) or OCT angiography (OCTA) alone. Together, these approaches can provide a more complete picture of anatomy, perfusion, vascular transit, leakage and inflammatory activity.
Approved ophthalmic use
Verdye is indicated for diagnostic use in ophthalmic angiography for the measurement of perfusion of the choroid.
The approved dose is 0.1–0.3 mg/kg body weight as an intravenous bolus injection. Always consult the locally approved prescribing information, as presentations and requirements may vary by territory.
BENEATH THE RETINAL PIGMENT EPITHELIUM
Why ICGA provides a different view
The choroid lies beneath the retinal pigment epithelium and contains one of the body’s most densely vascularised circulations. This depth, together with overlying pigment and exudation, can make the choroidal vasculature difficult to assess using visible-light techniques alone.
Following intravenous administration, indocyanine green binds rapidly and extensively to plasma proteins. Near-infrared excitation and emission provide greater penetration through melanin, xanthophyll, haemorrhage and serosanguineous fluid than visible-light fluorescence. Because ICG is highly protein-bound, it’s early-phase leakage through choriocapillaris is relatively limited and therefore medium and large choroidal vessels can remain delineated.
ICGA captures the passage of fluorescence over time. Early, middle and late phases may reveal different patterns of filling, vascular architecture, hyperpermeability and hypocyanescence. Interpretation depends on the clinical question, acquisition protocol and findings from other imaging modalities.
“ICG based fluorescence is an essential requirement for specialised retinal clinics at tertiary referral hospital eye services.”
WHERE ICGA IS USED
Clinical Focus Areas
ICGA is used by ophthalmology specialists when the clinical question centres on the choroidal circulation or when deeper vascular detail is not adequately characterised by other imaging alone. The three focus areas below reflect clinical practice and the published literature; they are not separate authorised indications for Verdye.
Authorised use and clinical focus
Verdye’s authorised ophthalmic use is diagnostic ophthalmic angiography for measurement of perfusion of the choroid. The named conditions below are clinical settings in which ICGA may support screening, differential assessment, lesion characterisation or follow-up. Always consult the locally approved prescribing information.
In medical retina, ICGA can add information when vascular lesions lie beneath the retinal pigment epithelium, or where pigment, exudation, pigment epithelial detachment or haemorrhage limits conventional angiographic detail. OCT remains central to routine structural diagnosis and monitoring; FA, OCTA and ICGA are added selectively to answer defined questions.
- Polypoidal choroidal vasculopathy (PCV): ICGA can delineate aneurysmal lesions and the branching neovascular network. OCT and OCTA can screen for suggestive features, while ICGA remains valuable when confirmation or detailed characterisation is clinically important.³,⁴
- Central serous chorioretinopathy (CSC): ICGA may demonstrate delayed filling, dilated choroidal vessels and areas of choroidal vascular hyperpermeability. Recent widefield studies further characterise venous drainage patterns in acute and chronic disease.⁵,⁶
- Macular neovascularisation (MNV): ICGA may support lesion characterisation, including recognition of type 3 MNV-historically termed retinal angiomatous proliferation (RAP)-and differentiation of PCV from other neovascular AMD phenotypes.⁷
ICGA can reveal the presence, distribution and evolution of choroidal inflammatory involvement that may not readily apparent on clinical examination or retinal imaging. Phase-dependent hypocyanescent areas, vascular fuzziness, staining and late diffuse hyperfluorescence may help define the location and extent of involvement in birdshot retinochoroiditis, Vogt–Koyanagi–Harada disease, multifocal choroiditis and other choriocapillaritis or stromal choroiditis entities.²,⁸
Recent Herbort-associated reviews emphasise multimodal assessment: ICGA provides global information on choroidal inflammatory involvement, while FA, EDI-OCT, OCTA and fundus autofluorescence contribute different retinal, structural and flow information.¹,²,⁸,⁹
ICG and fluorescein angiography have also been studied in corneal neovascularisation. Small clinical series suggest that angiography can help map vessel depth and topography and identify feeder vessels before selected interventions. A 2024 review describes a developing field in which angiography, anterior-segment OCT and anterior-segment OCTA may provide complementary information.¹⁰,¹¹ This literature-described application is not part of Verdye’s authorised ophthalmic indication and requires territory-specific review before external use.
IN SUMMARY
Conclusion
ICGA remains a clinically important component of multimodal ophthalmic imaging when the diagnostic question centres on choroidal perfusion, vascular architecture or inflammatory involvement.
Its ability to capture dynamic choroidal filling, hyperpermeability and late fluorescence patterns-and to retain visibility through pigment, fluid and some haemorrhage-provides information that OCT and OCTA cannot supply directly.
OCTA offers important advantages as a non-invasive, depth-resolved and readily repeatable technique. ICGA is used selectively where its distinct angiographic information can confirm or refine diagnosis, characterise the extent of choroidal involvement and support clinical assessment.
The multimodal context
FA provides dynamic information on retinal circulation and vascular leakage, while OCT provides high-resolution structural anatomy. ICGA and FA are often performed together, with OCT and OCTA adding structural and depth-resolved flow information according to the clinical question.
ICGA versus OCTA:
Understanding their different diagnostic roles
ICGA and OCTA answer different clinical questions. OCTA provides non-invasive, depth-resolved flow maps; ICGA has clear advantages where dynamic choroidal transit, leakage or hyperpermeability, visibility through pigment or haemorrhage, confirmation of PCV, or a wider assessment of choroidal involvement is required.
Recent reviews associated with author Carl. P. Herbort position OCTA as a valuable adjunct that does not replace established angiography where dynamic vascular, leakage or global choroidal inflammatory information is needed.¹,²
ICGA
OCTA
Records fluorescence through early, middle and late phases, providing dynamic information on choroidal filling and vascular transit.
Produces depth-resolved maps of detected flow. It does not directly show contrast-agent transit or the same phase-dependent haemodynamic sequence.
Can demonstrate vessel staining, choroidal hyperpermeability and characteristic late fluorescence or leakage patterns-information that can be important in Central Serous Chorioretinopathy and inflammatory choroidal disease.
Does not directly demonstrate vascular leakage or hyperpermeability. Activity must be inferred from flow and accompanying structural findings.
Near-infrared fluorescence penetrates the retinal pigment epithelium and can preserve choroidal vascular detail through pigment, exudation, serosanguineous fluid and some haemorrhage.
Provides layer-by-layer vascular detail without intravenous contrast, but segmentation can be less reliable where anatomy is distorted by pigment epithelial detachment, fluid or other pathology.
Remains the reference angiographic method for confirming PCV and characterising aneurysmal lesions and branching neovascular networks, particularly where non-invasive imaging findings are inconclusive.³,⁴
Can screen for vascular features associated with PCV and provide depth-resolved vascular detail, but slow flow, shadowing and segmentation errors may reduce lesion visibility in some eyes.
Widefield or ultra-widefield acquisition can provide a more global view of choroidal vascular and inflammatory involvement, depending on the imaging system and protocol.
Field of view can be limited – resolution and acquisition time remain interdependent.
Image interpretation is not dependent on automated retinal-layer segmentation. ICGA can also be paired with FA to assess choroidal and retinal circulation and leakage in the same multimodal work-up.
Motion, projection and segmentation artefacts-and flow below the detection threshold-can create false or missing vascular signals and require careful correlation with structural OCT.
Requires intravenous administration and the associated prescribing, hypersensitivity and emergency precautions.
Non-invasive and readily repeatable, which is a clear advantage for serial assessment.
PRODUCT PROFILE
Practical considerations supporting Verdye
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Established vial presentation available in 25 mg strength
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Contains no excipients
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Five-year unopened shelf life
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Approved ophthalmic angiography dose of 0.1–0.3 mg/kg body weight by intravenous bolus injection
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Cleared by the liver and excreted unchanged and unconjugated into the bile
After reconstitution, the solution should be used as directed in the locally approved prescribing information. Product presentation, storage, shelf life and preparation instructions may vary by territory.
SAFETY AND PRESCRIBING INFORMATION
Verdye is for diagnostic use and should be administered under the supervision of a physician. Hypersensitivity reactions, including severe anaphylactic reactions, may occur. Appropriate emergency equipment and medicines should be readily available.
Contraindications, warnings, precautions and dose limits-including age-specific total daily doses-are set out in the locally approved prescribing information. Always review the current Summary of Product Characteristics or equivalent local document before use.
REFERENCES
1. Herbort CP Jr, Papasavvas I, Mantovani A, et al. Optical coherence tomography angiography (OCT-A) in uveitis: a literature review and a reassessment of its real role. Diagnostics (Basel). 2023;13(4):601. doi:10.3390/diagnostics13040601.
2. Herbort CP Jr, Papasavvas I. Review on imaging methods in non-infectious posterior uveitis, principles, relevance, and practical clinical applications to disease entities. Ukrainian Journal of Ophthalmology. 2023;(2):39–59. doi:10.31288/oftalmolzh20233959.
3. Cheung CMG. Macular neovascularization and polypoidal choroidal vasculopathy: phenotypic variations, pathogenic mechanisms and implications in management. Eye (Lond). 2024;38:659–667. doi:10.1038/s41433-023-02764-w.
4. Cheung CMG, Lai TYY, Teo K, et al. Polypoidal choroidal vasculopathy: consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmology. 2021;128:443–452. doi:10.1016/j.ophtha.2020.08.006.
5. Akilesh MS, Kumar G, Murthy S, et al. Ultra-wide field indocyanine green angiography in central serous chorioretinopathy. Indian J Ophthalmol. 2024;72(Suppl 4):S606–S609. doi:10.4103/IJO.IJO_1852_23. PMID:38770620.
6. Hao X, He G, Li M, et al. Widefield indocyanine green angiography evaluating choroidal vein drainage pattern and choroidal vein alterations in acute and chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther. 2024;50:104358. doi:10.1016/j.pdpdt.2024.104358.
7. Ravera V, Bottoni F, Giani A, et al. Retinal angiomatous proliferation diagnosis: a multi-imaging approach. Retina. 2016;36(12):2274–2281.
8. Papasavvas I, Tucker WR, Mantovani A, Fabozzi L, Herbort CP Jr. Choroidal vasculitis as a biomarker of inflammation of the choroid: indocyanine green angiography spearheading diagnosis and follow-up-an imaging tutorial. J Ophthalmic Inflamm Infect. 2024;14:63. doi:10.1186/s12348-024-00442-w.
9. Accorinti M, Berkenstock MK, Cicinelli MV, et al. Systematic review of clinical utility of multimodal imaging in noninfectious posterior uveitis: MUV Project Report 3. Am J Ophthalmol. 2025;279:56–77. doi:10.1016/j.ajo.2025.07.002.
10. Wen Y, et al. Recent advances in corneal neovascularization imaging. Exp Eye Res. 2024;244:109930. doi:10.1016/j.exer.2024.109930.
11. Steger B, Romano V, Kaye SB. Corneal indocyanine green angiography to guide medical and surgical management of corneal neovascularization. Cornea. 2016;35(1):41–45. doi:10.1097/ICO.0000000000000683.
12. The Royal College of Ophthalmologists. Ophthalmic Services Guidance: Ophthalmic Imaging. 2021.
13. Diagnostic Green Limited. Verdye 5 mg/ml powder for solution for injection: Summary of Product Characteristics. Revised June 2025. https://www.hpra.ie/find-a-medicine/for-human-use/authorised-medicines/details/38844
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