Introduction To Fluorescein Angiography PowerPoint Presentation

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Introduction To Fluorescein Angiography Saleh A. Al Amro, FRCS Head of Retina – Vitreous Division KSU

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Described in 1959 by MacLean and Maumenee IV FAA or oral FFA Angiography or Angioscopy Emergency kit FFA

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Characteristics of Fluorescein Nontoxic, inexpensive, safe Alkaline solution Highly fluorescent Absorbs blue light (480-500 nm) Emits yellow-green (500-600 nm [525 nm]) Effective at pH 7.37-7.45 Removal from blood by kidneys and liver within 24 hrs. FFA

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Informed consent Anticubital vein, 21 G needle Rapid injection of 5 cc of 10% Na Fl, or 3 cc of 25% solution – within 2 seconds Flush with a saline solution Early photos of 1 second. Take, OU Stereoscopic FFA FFA

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During Pregnancy and Lactation Controversial Fl. Crosses the placenta Has been done in pregnancy with no adverse effect Do it when necessary FFA

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Hazards Minimal relatively safe drug Use of dilating drops Red after – images from the photoflash Temporary tan skin color Fl. Urine discoloration Interfere with serological tests FFA

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Hazards cont … 2-4% Transient nausea and occ. VOMITING Hives, asthmatic symptoms Laryngeal edema Rarely – Syncope, anaphylactic rxn, MI, resp. or Cardiac arrest Rx – oral or I.V. Benadryl or Cortisone A physician in the 1st few minutes FFA

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Anatomic and Physiologic Considerations Retinal B.V. , choricapillaris, large choroidal vessels Optic disc – normal fluorescent, no leakage Ciliary body leaks dye in A/C and vitreous FFA

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Anatomic and Physiologic Considerations Fovea to disc = 4 mm (15o) FAZ – 25-1500 u (350 u) Pigment filters – Melanin, xanthophyll, lipofuscin RPE – anatomic variations Outer BRB, Bruch’s membrane Inner BRB FFA

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Anatomic and Physiologic Considerations B.V. appears larger with FFA than with colors A major vein at the disc = 150 u Capillary - free zone around arteries and veins Macula - Clinical (within temporal arcades) - Anatomic (1500 u) Fovea (1500 u) FFA

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Angiographic Analysis Sequential Anatomic Morphologic Be systematic – comment on the choroid, retina, disc and macula FFA

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Normal Arm-to-retina circulation time is 12-15 sec. Five angiographic phases: Pre arterial Arterial Arteriovenous Venous Recirculation FFA

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Normal cont… Choroidal filling – segmental (patchy) Laminar venous filling Macular hypofluorescence A-V Transit time up to 11 - 12 Sec. Scleral staining Disc fluorescence FFA

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Hyperfluorescence Leak Transmission increase Abnormal vessels

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Leak Pooling (in a space) Staining (in a tissue). Pigment epithelial window defect Retinal Subretinal Tumors Abnormal Vessels Transmission increase

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Hyperfluorescence Leak Pooling (in a space) Staining (in a tissue). Retinal Subretinal Retinal Subretinal Cystoid edema Perivascular staining Retinal pigment epithelium Noncystoid edema Drusen Scars Sclera Lamina cribrosa Sensory retina detachment

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Hyperfluorescence Transmission Increase Pigment Epithelial Window Defect Atrophy Drusen

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Hyperfluorescence Abnormal Vessels Retinal Subretinal Tumors Tortuosity and Dilation Neovascularization Aneurysms Telangiectasias Shunts and collaterals Vessels in scar Macroaneurysms Neovascularization Retinal Subretinal Angioma Retinoblastoma Microaneurysms Hemangioma Melanoma Metastases

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Hypofluorescence Transmission Decrease (blocking effect) Filling defect (delay and occlusion)

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Hypofluorescence TransmissioncDecrease (blocked) Pigment Exudates Edema and transudate Other abnormal materials Melanin Hemoglobin Xanthophyll Lipofuscin Hard Soft Best`s disease Foreign body Fundus flavimaculatus

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Hypofluorescence Filling defect (delay and occlusion) Retinal Subretinal Artery Vein Capillary bed Loss of tissue Nonperfusion Dystrophies Degeneration Choroideremia Choroidal atrophy etc. Myopia Central areolar atrophy

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Retinal vascular disorders Macular disorders Tumors O.N. lesions Other fundus lesions Iris fluorescein angiography FFA

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Not all abnormal conditions of the ocular fundus will produce abnormal fluorescein angiograms. FFA Things to remember

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Thank You For Your Attention! شكراً