UltraGreen.ai - A global leader in fluorescence-guided surgery

A global leader in fluorescence-guided surgery (SGX: ULG) - Not Rated

UltraGreen.ai is a global leader in fluorescence-guided surgery (FGS), specialising in the development, contracting manufacture, and commercialisation of indocyanine green (ICG) — a sterile injectable fluorophore that has become integral to modern surgical practice. 

ICG illuminates real-time tissue perfusion, vascular structures, biliary anatomy and tumour margins when activated under near-infrared (NIR) light. 

Because these visual cues are essential for improving surgical precision, ICG has become a mission-critical consumable across oncology, gastrointestinal, hepatobiliary, cardiovascular, plastic reconstructive, and transplant surgery.

UltraGreen’s leadership is the result of more than a decade of sustained investment in regulatory approvals, quality systems, clinical partnerships, and global distribution capabilities. 

The company now has one of the broadest regulatory footprints among fluorescence imaging agents: its ICG product is registered in 35 countries and distributed under exemption pathways in another 33 markets, giving it active commercial presence in 68 countries across the Americas, Europe, Middle East & Africa (EMEA), and Asia-Pacific. 

The breadth of this reach is a substantial competitive barrier, as sterile injectables require extensive documentation, validated manufacturing processes, and GMP-compliant facilities—difficult hurdles for new entrants and generics manufacturers.

UltraGreen’s operating model includes reliance on third-party manufacturing and distribution partners. 

The company discloses exclusive active pharmaceutical ingredient (API) supply arrangements and an outsourced manufacturing strategy using contract manufacturing organisations (CMOs) with experience in sterile injectables. 

Product distribution is conducted through a global network of 55 third-party distributors.

Clinical engagement is described as part of the company’s commercial approach. 

The prospectus states that UltraGreen works with over 90 key opinion leaders (KOLs) globally and sponsors the International Society for Fluorescence Guided Surgery (ISFGS). 

These activities support surgeon education, training and awareness of fluorescence-guided techniques.

Industry outlook: fluorescence-guided surgery

Global adoption trends and structural underpenetration

Fluorescence-guided surgery (FGS) is a surgical technique that uses fluorescent agents, such as indocyanine green (ICG), together with near-infrared (NIR) imaging systems to enhance intraoperative visualisation. 

The typical FGS workflow involves intravenous or local administration of ICG, followed by activation of NIR imaging to visualise blood flow, lymphatic drainage, biliary anatomy, tissue perfusion, and tumour margins in real time. 

According to Frost & Sullivan, the use of fluorescence imaging has been validated across a wide range of procedures, including lymphatic mapping, anastomotic perfusion assessment, bile duct identification, organ perfusion assessment, tumour margin visualisation, and minimally invasive surgery.

Despite its documented clinical applications, adoption of FGS remains at an early stage globally. 

Frost & Sullivan estimates indicate that penetration of FGS in the United States is below 25% of eligible procedures, reflecting historical constraints such as limited availability of NIR-compatible imaging systems, uneven surgeon training, and differences in reimbursement practices. 

Adoption levels are lower across Asia-Pacific, Latin America and Eastern Europe, where hospital infrastructure, standardisation of surgical practices and access to advanced imaging equipment vary significantly by country. 

These regional differences are reflected in the penetration data which show materially lower usage rates in several emerging markets compared with the United States, Europe and selected developed Asian markets.

Frost & Sullivan’s analysis further documents the clinical and economic implications of improved visualisation across selected surgical specialties. 

For example, in laparoscopic cholecystectomy, visual misperception is identified as a major contributor to bile duct injury, which carries significant financial and medico-legal consequences. 

Similarly, in colorectal surgery, anastomotic leaks are associated with extended hospital stays and higher treatment costs, while in breast reconstruction, inadequate perfusion assessment can lead to flap necrosis and re-operations. 

Frost & Sullivan attributes reductions in complication rates and associated costs in these procedures to the use of fluorescence imaging, based on published clinical studies.

According to Frost & Sullivan, the expansion of this ecosystem has been supported by increasing installation of NIR-enabled laparoscopic and robotic systems, growing volumes of clinical literature evaluating fluorescence-guided techniques, and wider dissemination of surgeon training and education programmes by industry participants and professional societies.

Regional growth outlook and APAC opportunity

Based on Frost & Sullivan estimates, the Asia-Pacific region is expected to be the fastest-growing market for ICG between 2024 and 2030, with a forecast compound annual growth rate of 16.6%. 

The region’s share of the global ICG market is projected to increase from approximately 9% to 14% over the same period. 

This growth is driven by increasing surgical volumes, gradual adoption of fluorescence-guided techniques, and ongoing investment in hospital infrastructure. 

Frost & Sullivan attributes regional growth to factors including rising procedural volumes in emerging markets, increasing adoption of surgical standards aligned with those used in North America and Europe, continued investment in operating-room modernisation, and the development of medical tourism hubs in markets such as Thailand and Singapore. 

Breadth of surgical applications

ICG is currently used across multiple surgical specialties, in ophthalmology, gastrointestinal surgery, oncologic surgery, plastic and reconstructive surgery, gynaecologic surgery, thoracic surgery, urology, neurosurgery, transplant surgery and cardiovascular surgery. 

According to Frost & Sullivan, the applications of ICG can be grouped into tissue perfusion assessment, sentinel lymph node mapping, anatomic imaging and tumour mass visualisation. 

Penetration of ICG usage differs materially by procedure type and country. 

Frost & Sullivan’s forward-looking penetration estimates for 2028 indicate higher expected adoption across most procedures and regions, although penetration remains uneven across countries and specialties.

Penetration varies widely by country. Mature markets such as the U.S. and Europe lead adoption, while markets such as Indonesia and Thailand are catching up rapidly.

Competitive landscape

The competitive landscape for ICG includes pharmaceutical manufacturers and, indirectly, medical device companies that offer fluorescence imaging systems bundled with fluorescent agents.

Market participants include Daiichi Sankyo, Hanlim Pharmaceutical, SERB Pharmaceuticals, Dongindang Pharmaceutical, Macsen Laboratories and Auro Laboratories, alongside imaging system manufacturers such as Stryker, which supplies ICG agents together with its fluorescence imaging platforms. 

Frost & Sullivan’s market share estimates indicate that UltraGreen holds a leading position globally, with a significantly larger share of ICG vials sold and revenue compared with individual competitors. 

Many competing suppliers operate in a limited number of markets, focus on specific clinical indications, or lack broad regulatory approvals across multiple regions.

Business model and strategic focus

UltraGreen’s business model is primarily based on the sale of ICG consumables, which account for more than 90% of its revenue, as disclosed in the prospectus. 

Each surgical procedure requires repeat purchase of ICG, which links revenue generation directly to procedural volumes rather than to hospital capital expenditure cycles. 

Manufacturing is outsourced to specialised contract manufacturing organisations, allowing the company to focus on regulatory approvals, distributor management and research and development. 

This asset-light structure contributed to cash conversion of 76.3% in FY2024, compared with 59.9% in FY2023, and 62.7% in 1H25, compared with 55.2% in 1H24, as disclosed in the prospectus.

The company’s stated strategic priorities include geographic expansion, particularly in Asia-Pacific, Europe and the Middle East; portfolio development through additional vial formats and formulations of ICG; and the development of its digital platform. 

The UltraGreen Data Platform, which is already generating early revenue, is intended to support real-time, AI-enabled perfusion quantification through the PerfusionWorks application. 

According to the prospectus, development of PerfusionWorks is expected to be completed by 2026, with commercial rollout targeted for 2027.

Rapid top-line growth, exceptional margins, and strong cash generation

UltraGreen has delivered rapid and consistent financial expansion, underpinned by strong pricing power, rising procedure volumes and meaningful operating leverage. 

Revenue increased from US$72.0 million in 2023 to US$114.7 million in 2024, representing a 59.3% year-on-year increase. 

Growth momentum continued into 1H25, with revenue rising 20.3% year-on-year to US$70.1 million, reflecting continued expansion in ICG volumes, favourable pricing dynamics and sustained demand across core markets.

Earnings growth has been equally strong. 

Net profit increased from US$33.0 million in 2023 to US$56.0 million in 2024, representing 69.4% year-on-year growth, driven by margin expansion and disciplined cost control. 

In 1H25, UltraGreen recorded net profit of US$25.7 million, a decline of 7.6% year-on-year. 

The net profit margin declined from 47.7% in 1H24 to 36.6% in 1H25, primarily due to foreign exchange losses of approximately US$7.0 million. 

These losses arose from the weakening of the U.S. dollar, which is the reporting currency, against the euro, the functional currency of its wholly-owned subsidiary, Renew Pharmaceuticals Limited. 

Cash flow generation remains a key strength. 

UltraGreen generated US$54.3 million in operating cash flow in FY2024, representing a 113% year-on-year increase, and delivered US$27.6 million in operating cash flow in 1H25, up 33% year-on-year. 

Cash conversion improved materially to 76% in FY2024, reflecting strong operating leverage and effective working capital management. 

IPO highlights and use of proceeds

The IPO raised US$400 million in total proceeds, comprising US$162.5 million from the public offering and US$237.5 million from cornerstone investors. The proceeds are intended to support product development, digital platform investment, Asia-Pacific expansion, and general corporate and working-capital requirements.

Key Risks

Key risks include reliance on concentrated active pharmaceutical ingredient (API) suppliers, regulatory scrutiny in sterile injectables, distributor performance and execution risks related to the AI platform. 

Valuation

Ultragreen’s trailing P/E is about 29.3x, based on its closing price of USD1.41 as of 19 December 2025. Its P/B ratio of 11.0x is the highest among its peers. 

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