BACKGROUND Manifestations of serpiginous choroidopathy have been well described, but very little is known about its true pathogenesis. By virtue of the enhanced imaging of the choroidal circulation, indocyanine green angiography may offer information on the causative factors of the disorder. METHODS Indocyanine Green (ICG) videoangiography was carried out in 17 patients with serpiginous choroidopathy. A full ophthalmological examination and intravenous fluorescein angiography were simultaneously done as well. The patients were studied at 3 different stages of the disease as follows: 1) with acute manifestations; 2) with subacute lesions; 3) in the inactive or healed state. RESULTS Acute Lesions: Indocyanine angiography showed active choroidal involvement in the acute stage beyond the limits delineated by corresponding fluorescein studies. Subacute Lesions: ICG angiography showed resolution of choroidal involvement in advance of clinical and fluorescein angiographic changes in some eyes. Healed Lesions: ICG angiography showed better delineation of the atrophic choroid with clearer definitions than corresponding fluorescein studies. Late staining of fibrovascular tissue within atrophic zones was similar to fluorescein findings. Two patients in the healed state showed multifocal hypofluorescence (one patient) and hyperfluorescent choroidal lesions (one patient) with no clinical or fluorescein counterparts, possibly representing occult lesions. CONCLUSIONS ICG angiography may be useful in understanding certain clinical features of the entity, such as a clearer documentation of the extent and nature of the choroidal damage and possible sites at risk for future recurrences. However, it adds little to our current management of the disorder.