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Fundus angiography PowerPoint Presentation

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Slide 1 - FUNDUS ANGIOGRAPHY 1. Fluorescein (FA) General principles Excitation and emission 2. Indocyanine green (ICG) Filters Photographic technique Phases of normal angiogram Causes of dark appearance of fovea Causes of hyperfluorescence Causes of hypofluorescence General principles Phases of normal angiogram
Slide 2 - General principles of FA Fluorescein 85% bound to serum proteins 15% unbound ‘free’ fluorescein Impermeable to fluorescein Outer blood-retinal barrier (zonula occludens) Impermeable to fluorescein Choriocapillaris Permeable only to ‘free’ fluorescein Inner blood-retinal barrier (retinal capillaries)
Slide 3 - Excitation and emission
Slide 4 - Filters
Slide 5 - Photographic technique 1. Take red-free photograph 2. Inject rapidly 5 ml of 10% solution 3. Take photographs at 1 sec intervals between 5-25 sec after injection 4. Take photographs after 10 min and 20 min, if appropriate
Slide 6 - Phases of normal FA Arterial Arterial filling Arteriovenous (capillary) Very early lamellar venous flow Early venous Marked lamellar venous flow Mid-venous Almost complete venous filling Late venous Complete venous filling Late Progressively weaker fluorescence Staining of disc
Slide 7 - Causes of dark appearance of fovea Avascularity Increased density of xanthophyll Large RPE cells with more melanin Blockage of background choroidal fluorescence by:
Slide 8 - Causes of hyperfluorescence ( 1 ) RPE ‘ window’ defect RPE atrophy (bull’s eye maculopathy Pooling of dye Under RPE (pigment epithelial detachment) Under sensory retina (central serous retinopathy)
Slide 9 - Causes of hyperfluorescence (2) Leakage of dye Prolonged dye retention ( staining ) Into sensory retina (cystoid macular oedema) From new vessels (choroidal neovascularization Associated with drusen
Slide 10 - Causes of hypofluorescence (1) Blocked retinal or choroidal fluorescence Blood under retinal pigment epithelium Preretinal or intraretinal blood Abnormal material Increased pigment
Slide 11 - Vascular occlusion Capillary non-perfusion (venous occlusion) Loss of vascular tissue Choroideremia or high myopia Causes of hypofluorescence (2)
Slide 12 - General Principles of ICG Angiography 1. Binding 98% bound to proteins 2. Fluorescence Much less than fluorescein Less leakage from choriocapillaris Excitation peak 800 nm Emission at 835 nm 3. Filters Infrared barrier and excitation 4. Safer than fluorescein
Slide 13 - Phases of normal ICG angiogram (1) Early (20 sec) Disc hypofluorescence Poor perfusion of vertical (watershed) zone near disc Prominent filling of choroidal arteries Early filling of choroidal veins Filling of retinal arteries but not veins Early middle (3 min) Filling of watershed zone Fading of choroidal arterial filling Prominent filling of choroidal veins Filling of retinal arteries and veins
Slide 14 - Phases of normal ICG angiogram (2) Late (21 min) Large choroidal and retinal vessels are empty Late middle (6 min) Reduced filling of choroidal vessels Diffuse hyperfluorescence due to diffusion of dye from choriocapillaris Persistent filling of retinal vessels Diffuse background hyperfluorescence
 

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