UltraGreen.ai: Illuminating the future of surgery

Initiation Coverage

UltraGreen.ai (SGX: ULG)

BUY: USD 1.68 

• Near-monopoly position in the global ICG market: UltraGreen.ai is the global leader in Indocyanine Green (ICG), with approximately 68% global vial market share and dominant positions in both the US and Europe.

• High-quality recurring revenue model: Every fluorescence-guided surgery (FGS) requires a new ICG vial, giving UltraGreen.ai a highly recurring revenue base that is driven primarily by surgical volumes rather than equipment replacement or patent cycles.

• Structural industry tailwinds: Growing clinical evidence, increasing robotic surgery adoption and the 2025 SAGES guidelines are accelerating the integration of FGS into routine clinical practice, supporting long-term ICG demand.

• Geographic expansion extends the runway: Following its success in the US and Europe, UltraGreen.ai is expanding across South and Southeast Asia and the Middle East through new regulatory approvals and the IC-Flow™ platform, supported by an asset-light distributor model.

• Attractive valuation with strong growth potential: Applying a 20x forward P/E to our 2028 forecasted earnings yields a target price of USD 1.86, implying 46.2% upside from the closing price on 9 July 2026. We therefore initiate coverage with a BUY recommendation.

For decades, surgeons have relied largely on experience and conventional white-light imaging to guide critical decisions during an operation. Today, that is beginning to change. As advanced imaging technologies become increasingly integrated into modern surgery, doctors are gaining greater visibility during procedures, improving surgical precision and supporting better patient outcomes.

UltraGreen.ai (SGX: ULG) is a Singapore-based health technology company specialising in fluorescence-guided surgery (FGS). Originally established as a niche pharmaceutical business, the company has evolved into an integrated surgical technology platform spanning pharmaceutical consumables, medical imaging devices and software solutions. Through this ecosystem, UltraGreen.ai aims to improve surgical precision by enhancing intraoperative visualisation and supporting more informed clinical decision-making.

Figure 1: Evolution of UltraGreen.ai

Source: UltraGreen.ai Annual Report 2025

During FGS, surgeons use specialised imaging technology together with Indocyanine Green (ICG) to improve visibility during an operation. ICG is administered to the patient prior to surgery and fluoresces under near-infrared light, allowing blood vessels, tissue perfusion and critical anatomical structures to become visible in real time. Compared with conventional white-light surgery, this provides surgeons with additional information to support more accurate clinical judgement and greater surgical consistency.

Figure 2: Example of surgical view with and without ICG

Source: UltraGreen.ai’s website

UltraGreen.ai's business is built around enabling this capability through a vertically integrated ecosystem comprising pharmaceutical consumables, imaging hardware and software. At the pharmaceutical layer, the company markets its ICG products under the IC-GREEN® brand in the US and Verdye® internationally. Complementing this is the IC-Flow™ imaging platform, which captures near-infrared fluorescence signals during surgery. Building on this hardware platform are the group's software solutions, including PerfusionWorks™ and UltraGreen.ai Data Systems (UGDS), which leverage quantitative analysis and artificial intelligence to assist surgeons in assessing blood flow, identifying critical anatomical structures and supporting intraoperative decision-making. Together, these three components form an integrated ecosystem that enhances surgical precision while reinforcing the adoption of FGS.

Figure 3: UltraGreen.ai's corporate structure

Source: UltraGreen.ai Annual Report 2025
Data as of 31 Dec 2025

Today, UltraGreen.ai has established a global commercial footprint, with its products sold in more than 55 countries. Despite this broad international presence, the Americas remain the company's largest revenue contributor, generating USD 106.5 million and accounting for 77.5% of continuing ICG revenue (excluding the discontinued UltraLinQ business and the nascent UGDS segment). This reflects UltraGreen.ai's strong position in its core markets while highlighting the significant opportunity for future international expansion.

Figure 4: Continuing ICG revenue remains concentrated in the Americas

Recent financial highlights

2025: Strong earnings growth following SGX listing

UltraGreen.ai delivered a strong set of 2025 results, its first full-year performance following its SGX listing in December 2025. Revenue from continuing operations increased 27.7% year-on-year to USD 137.9 million, supported by both higher shipment volumes and average selling prices. Gross profit reached USD 117.1 million, translating into an industry-leading gross margin of 84.9%. The stability of margins despite higher sales volumes validates UltraGreen.ai's asset-light manufacturing model and supports management's long-term gross margin target of approximately 85%.

The group also maintained a strong financial position, ending 2025 with a debt-free balance sheet and net cash of USD 176.1 million. This provides substantial financial flexibility to support geographic expansion, product development and potential strategic investments.

1Q 2026: Operational momentum remains intact

UltraGreen.ai's 1Q 2026 business update indicated that operational momentum remains healthy. Total ICG vial shipments increased 7.8% quarter-on-quarter to 280.9K vials, with growth led by international markets, where shipments rose 18.1% following recent regulatory approvals. While reported shipments declined year-on-year due to an unusually high comparison base created by backlog fulfilment in 1Q 2025, underlying demand remained consistent with management's expectations. Management has guided 2026 revenue of USD 170–190 million, implying year-on-year growth of 23–38% over 2025 revenue from continuing operations.

Industry entering an inflection point as FGS and ICG adoption accelerate

The FGS industry is approaching a key inflection point, transitioning from early clinical adoption towards broader integration into routine surgical practice. As hospitals increasingly prioritise better patient outcomes, lower complication rates and greater operating efficiency, FGS is becoming an integral part of procedures ranging from colorectal and hepatobiliary surgery to cardiovascular, reconstructive and oncological operations. This transition is supported by a growing body of clinical evidence and increasing endorsement from professional surgical societies, accelerating adoption across multiple surgical specialties.

As FGS becomes more widely adopted, demand for ICG is expected to grow in tandem. Among available fluorescent agents, ICG has established itself as the industry standard, supported by its long-established safety profile, broad clinical applicability, compatibility with virtually all commercially available fluorescence imaging platforms, and significantly lower cost than newer targeted fluorophores. As a pharmaceutical consumable that is required for every fluorescence-guided procedure, rising surgical volumes translate directly into recurring demand for ICG, creating an attractive growth profile driven by increasing utilisation rather than capital equipment replacement.

A significant catalyst for ICG adoption came with the publication of the 2025 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines. Developed using the internationally recognised GRADE methodology, the guidelines issued a strong recommendation for the use of ICG fluorescence imaging during left-sided colorectal anastomosis based on seven randomised controlled trials involving 2,501 patients. Beyond representing clinical best practice, such guidelines increasingly influence hospital protocols, quality assurance programmes and reimbursement decisions, accelerating the incorporation of ICG into routine surgical practice.

Reflecting these favourable industry dynamics, the global FGS imaging systems market is projected to expand from approximately USD 128 million in 2025 to USD 304 million by 2031, representing a CAGR of 15.7%. Meanwhile, the global ICG market is expected to grow from USD 173 million in 2024 to USD 335 million by 2030, implying a CAGR of approximately 11.6%. Importantly, current utilisation remains well below estimated full market penetration, with the total addressable market exceeding USD 900 million, suggesting substantial headroom for continued growth as adoption expands across additional procedures, hospitals and geographic markets.

Robotic surgery provides a structural demand multiplier

Beyond growing clinical acceptance, the rapid adoption of robotic and minimally invasive surgery provides another powerful structural tailwind for the FGS ecosystem. The global installed base of robotic surgical systems has expanded from approximately 3,600 units in 2015 to more than 11,000 units in 2025, while integrated near-infrared imaging capabilities are increasingly becoming standard features on next-generation surgical platforms.

Unlike earlier-generation systems, fluorescence imaging is now being embedded into robotic platforms as a core capability rather than offered as an optional upgrade. As surgeons increasingly incorporate fluorescence imaging into routine practice, utilisation of FGS is expected to broaden across a growing range of procedures. This trend is already evident in the latest generation of robotic systems. According to UltraGreen.ai's 1Q 2026 update, more than 60% of newly installed da Vinci Xi and da Vinci 5 systems shipped in 2025 were equipped with the Firefly near-infrared imaging module, up from 42% in 2023.

Importantly, while robotic systems represent a one-off capital investment, ICG remains a recurring pharmaceutical consumable that must be purchased for every fluorescence-guided procedure regardless of the imaging platform used. Consequently, every additional robotic platform installed permanently expands the installed base capable of performing FGS, creating recurring demand for ICG over the life of the system.

Recurring consumables model drives visible earnings growth

UltraGreen.ai combines two characteristics that rarely coexist within the healthcare sector: a recurring pharmaceutical consumables business model and a dominant market position. Unlike many medical device manufacturers, whose revenues depend on periodic equipment replacement, UltraGreen.ai generates recurring revenue from every FGS performed. As each procedure requires a new ICG vial, demand is driven primarily by surgical volumes rather than capital expenditure cycles or product refresh cycles. Combined with its leadership in the global ICG market, this recurring revenue model not only provides strong earnings visibility but also enables the company to benefit from two growth drivers: volume growth and pricing power.

Management expects volume growth to be the primary driver of revenue growth. This is supported by the large and still underpenetrated market for FGS. Laparoscopic surgery—a minimally invasive technique used in common procedures such as gallbladder removal, colorectal surgery and appendectomy—is one of the highest-volume surgical modalities globally. As fluorescence imaging is increasingly incorporated into these procedures to improve intraoperative visualisation, demand for ICG consumables is expected to rise in tandem. With more than 15 million laparoscopic procedures performed globally each year, but fluorescence guidance still used in only a small proportion of eligible cases, UltraGreen.ai retains a substantial runway for volume growth within its existing addressable market.

The second growth driver is pricing power. Supported by its dominant market position, UltraGreen.ai implemented a 22% increase in US average selling prices (ASP) in 3Q2025, with the full-year earnings benefit expected to flow through in 2026. Despite this increase, the company's US pricing remains below comparable products, suggesting further scope for price optimisation over time. While we expect ASP growth to moderate following the 2026 uplift, pricing should remain a meaningful contributor to long-term earnings growth alongside continued volume growth.

Taken together, UltraGreen.ai's recurring consumables business model generates recurring revenue from a growing demand base, while its market leadership provides pricing power. These structural advantages provide a highly visible earnings profile and support sustained revenue and earnings growth over the medium term.

Institutional adoption creates a self-reinforcing demand flywheel

As discussed in the Industry Overview, FGS is approaching an important inflection point, supported by a growing body of clinical evidence and increasing endorsement from professional surgical societies. While these developments are expected to accelerate industry adoption, their significance extends beyond simply expanding the addressable market.

The commercialisation pathway for surgical technologies such as ICG is largely institutional. Once a clinical practice is supported by robust evidence and incorporated into professional guidelines, adoption typically progresses from leading academic centres to community hospitals before eventually becoming part of routine clinical practice. This process is reinforced through hospital procurement policies, surgeon training and clinical protocols, making adoption increasingly independent of individual purchasing decisions.

The publication of the 2025 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines represents an important milestone in this transition. The guidelines establish a recognised clinical benchmark that hospitals, credentialing bodies and healthcare institutions can reference when standardising surgical protocols. This could serve as a key catalyst for broader institutional adoption of ICG.

Beyond influencing clinical practice, institutional adoption also creates favourable economic incentives across the broader healthcare ecosystem. Hospitals are increasingly willing to adopt technologies that have been proven to improve patient outcomes while reducing costly postoperative complications. At the same time, insurers have stronger justification to reimburse interventions supported by robust clinical evidence and favourable health-economic outcomes. As reimbursement becomes more established and hospitals further standardise the use of ICG, adoption is likely to become increasingly self-reinforcing, creating a virtuous cycle of broader utilisation, greater clinical familiarity and recurring demand for ICG consumables.

Although the adoption process is gradual, with new clinical guidelines typically taking two to three years to become fully embedded into routine clinical practice, we expect the demand benefits of the 2025 SAGES guidelines will emerge progressively from 2028 onwards, providing UltraGreen.ai with a durable long-term earnings tailwind.

Geographic expansion extends the growth runway

Having established leading positions in the US and Europe, UltraGreen.ai is now entering the next phase of growth by selectively targeting markets that lack established domestic ICG suppliers. Rather than competing directly in markets such as China and Japan, where domestic manufacturers are already well established, the company is prioritising expansion across South and Southeast Asia and the Middle East, where competitive intensity is lower and opportunities for market entry are more attractive.

During 1Q 2026 alone, UltraGreen.ai secured ICG approvals in six new markets—Saudi Arabia, Kuwait, Colombia, the Philippines, Georgia and Singapore—bringing its global ICG footprint to 41 countries. In parallel, approvals for its IC-Flow™ imaging system were obtained in India, Thailand, the Philippines, Bangladesh and Malaysia, while regulatory submissions remain ongoing across approximately 20 additional markets in Asia and the Middle East, providing a visible pipeline for future commercialisation.

Importantly, IC-Flow™ should not be viewed as a standalone hardware growth story, but rather as an ecosystem enabler that accelerates ICG adoption. In many emerging markets, the adoption of FGS remains constrained by the high cost and infrastructure requirements of conventional imaging platforms. UltraGreen.ai's portable IC-Flow™ system lowers these barriers by providing hospitals and outpatient surgical centres with a more affordable entry point into FGS. As access to fluorescence imaging expands, demand for ICG consumables is expected to grow alongside surgical volumes, reinforcing the company's recurring revenue model.

Beneficiary of Singapore's capital market revitalisation

UltraGreen.ai is well positioned to benefit from Singapore's ongoing capital market revitalisation initiatives. The company is already a research beneficiary under the enhanced Grant for Equity Market Singapore (GEMS) scheme, which supports independent equity research for eligible Singapore-listed companies. Broader research coverage enhances investor awareness and helps attract greater retail and institutional participation, particularly for newly listed companies.

In addition, UltraGreen.ai was included in the iEdge Singapore Next 50 Index during the March 2026 quarterly review. The index could form the basis of future passive investment products, including ETFs and index-tracking funds. As assets tracking the index emerge over time, UltraGreen.ai could benefit from incremental passive fund inflows, further enhancing its market visibility and trading liquidity.

PerfusionWorks™ FDA clearance unlocks a higher-value software platform

While UltraGreen.ai's investment case is currently driven primarily by its ICG consumables business, PerfusionWorks™ represents a meaningful source of upside that is not reflected in current earnings expectations.

PerfusionWorks™ is UltraGreen.ai's real-time perfusion quantification software platform, designed to transform fluorescence imaging from a qualitative visual assessment into an objective, data-driven decision support tool. The platform has received FDA 510(k) clearance and is currently undergoing European Medical Device Regulation (MDR) review.

Comparable peer selection

Identifying a directly comparable listed peer for UltraGreen.ai is inherently challenging. No listed company combines a dominant position in the global ICG market with a recurring pharmaceutical consumables business model tied to FGS. UltraGreen.ai therefore sits at the intersection of pharmaceuticals, medical technology and surgical imaging, making a conventional peer comparison insufficient.

Accordingly, we adopt a two-peer framework that evaluates UltraGreen.ai across two complementary dimensions: business model similarity and surgical technology quality. Rather than seeking a single identical peer, this approach establishes a reasonable valuation range by referencing companies that share UltraGreen.ai's key commercial characteristics.

Lantheus Holdings — Primary business model comparable

Lantheus Holdings is the closest listed analogue to UltraGreen.ai's business model. Its flagship product, PYLARIFY®, is a specialist pharmaceutical imaging agent administered once per diagnostic procedure, generating recurring revenue that is directly linked to procedure volumes.

This closely resembles UltraGreen.ai's ICG business, where every FGS requires a new vial regardless of the imaging platform used. In both cases, the pharmaceutical agent—not the imaging hardware—forms the primary commercial asset, while expanding clinical adoption and installed imaging capacity drive recurring consumable demand.

Stryker — Surgical technology quality reference

Stryker serves as a reference for the quality of UltraGreen.ai's surgical platform rather than its business model. Through its SPY fluorescence imaging platform, Stryker is an established participant in FGS and distributes ICG products within the US.

However, Stryker's valuation is driven primarily by its diversified medical device portfolio, capital equipment replacement cycles and service revenues, making it less directly comparable to UltraGreen.ai's pharmaceutical consumables business. We therefore view Stryker as a quality benchmark and an appropriate reference rather than the primary valuation anchor.

Table 1: Comparable valuation metrics

Fair P/E

Given the close similarity in business model, Lantheus represents the most appropriate valuation benchmark for UltraGreen.ai. Accordingly, a fair P/E of 20x is assigned, in line with Lantheus' long-term average forward P/E.

Although UltraGreen.ai is expected to deliver materially stronger earnings growth than both Lantheus and Stryker over 2026–2028, valuing the company broadly in line with Lantheus' through-the-cycle multiple strikes an appropriate balance. This approach recognises UltraGreen.ai's relatively short-listed track record while reflecting the strength of its recurring revenue model, dominant market position and attractive long-term growth prospects.

Applying a 20x fair P/E to our 2028 forecasted earnings yields a target price of USD 1.86, representing 46.2% upside from the closing price on 9 July 2026. We therefore initiate coverage with a "Buy" rating.

UltraGreen.ai's leading position in the global ICG market, recurring consumables business model, expanding clinical adoption and long runway for international expansion provide a compelling foundation for sustained earnings growth. These structural strengths are not yet fully reflected in the current valuation, presenting an attractive long-term investment opportunity.

Table 2: UltraGreen.ai earnings forecasts

Revenue concentration in the US market

UltraGreen.ai remains heavily reliant on the US market, which contributed approximately 77.5% of group revenue in 2025. The company's 2026 earnings outlook also benefits from the full-year impact of the US price increase implemented in 3Q2025. Consequently, any adverse developments in the US—such as changes in hospital procurement policies, regulatory actions or disruptions involving key distribution partners—could have a disproportionate impact on revenue and earnings.

Although expansion into Asia-Pacific and the Middle East should gradually diversify the group's revenue base, we expect the US to remain UltraGreen.ai's largest earnings contributor throughout our forecast period.

Supply chain and manufacturing disruption

UltraGreen.ai operates an asset-light manufacturing model, relying on specialised third-party manufacturers for both active pharmaceutical ingredient (API) production and final product manufacturing. While this supports the company's industry-leading margins, it also exposes operations to potential supply chain disruptions beyond its direct control.

This risk was demonstrated during the 2024 lyophilisation disruption, which temporarily constrained production and affected shipment volumes. Although management has strengthened supply resilience by adding TopChem as a second API supplier, commercial production is only expected to commence in 2026, meaning supply concentration will remain relatively elevated in the near term. Any manufacturing disruption, regulatory issue or quality control incident involving key suppliers could temporarily constrain product availability and delay revenue recognition.

Concentrated shareholding and corporate governance

UltraGreen.ai's controlling shareholder, Renew Group Private Limited, which is wholly owned by Group CEO Ravinder Sajwan, continues to hold approximately 61.9% of the company's shares following its IPO. This gives the founder effective control over strategic decisions and shareholder resolutions.

While founder-led companies often benefit from strong strategic alignment and a long-term management approach, the concentrated ownership structure limits the influence of minority shareholders and heightens governance considerations, particularly in relation to related-party transactions, capital allocation and shareholder rights. As UltraGreen.ai continues to mature as a listed company, investors should monitor its corporate governance practices and execution of minority shareholder protections.

iFAST Research rating system

iFAST Research employs a five-tier rating system: Buy (material upside potential, favourable risk-return); Accumulate (moderate upside, selectively add on weakness); Hold (limited upside, maintain existing positions); Trim (upside insufficient to justify a full position, reduce exposure on strength); and Sell (material downside risk, exit position).

Disclaimer

For specific disclosure, at the time of publication of this report, IFPL (via its connected and associated entities) holds a position in UltraGreen.ai (as of 18 March 2026). The analyst who produced this report hold a NIL position in the abovementioned securities.

This research report is produced under the Grant for Equity Market Singapore (“GEMS”) Scheme. iFAST Financial Pte Ltd receives financial compensation for the preparation and publication of this report. For more information regarding the GEMS scheme and its objectives, please refer to this infographic. iFAST Financial Pte Ltd maintains editorial independence regarding the analysis and conclusions presented herein.