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Introduction To Introduction To Fluorescein AngiographyFluorescein Angiography
Saleh A. Al Amro, FRCS
Head of Retina – Vitreous Division
KSU
• Described in 1959 by MacLean and Maumenee
• IV FAA or oral FFA• Angiography or Angioscopy• Emergency kit
FFA
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
• 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
During Pregnancy and Lactation
• Controversial• Fl. Crosses the placenta• Has been done in pregnancy
with no adverse effect• Do it when necessary
FFA
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
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
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
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
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
Angiographic Analysis
• Sequential• Anatomic• Morphologic• Be systematic – comment on the
choroid, retina, disc and macula
FFA
Normal
• Arm-to-retina circulation time is 12-15 sec.• Five angiographic phases:
• Pre arterial• Arterial• Arteriovenous• Venous• Recirculation
FFA
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
Hyperfluorescence Hyperfluorescence
LeakLeak
Transmission increase Transmission increase
Abnormal vessels Abnormal vessels
LeakLeak
Pooling (in a space)Pooling (in a space)
Staining (in a tissue).Staining (in a tissue).
Pigment epithelial window defect Pigment epithelial window defect
Retinal Retinal
Subretinal Subretinal Tumors Tumors
Abnormal Vessels
Abnormal Vessels
Transmission increase
Transmission increase
Hyperfluorescence Hyperfluorescence LeakLeak
Pooling
(in a space)
Pooling
(in a space)
Staining
(in a tissue).
Staining
(in a tissue).
Retinal Retinal
Subretinal Subretinal
Retinal Retinal
Subretinal Subretinal
Cystoid edema Cystoid edema
Perivascular staining Perivascular staining
Retinal pigment epitheliumRetinal pigment epithelium
Noncystoid edema Noncystoid edema
DrusenDrusen
Scars Scars
Sclera Sclera
Lamina cribrosa Lamina cribrosa
Sensory retina detachmentSensory retina detachment
Hyperfluorescence Hyperfluorescence Transmission
Increase
Transmission
Increase
Pigment
Epithelial
Window
Defect
Pigment
Epithelial
Window
Defect
Atrophy Atrophy
Drusen Drusen
Hyperfluorescence Hyperfluorescence Abnormal
Vessels
Abnormal
Vessels
Retinal Retinal
Subretinal Subretinal
Tumors Tumors
Tortuosity and Dilation Tortuosity and Dilation
Neovascularization Neovascularization Aneurysms Aneurysms
Telangiectasias Telangiectasias
Shunts and collaterals Shunts and collaterals
Vessels in scar Vessels in scar
MacroaneurysmsMacroaneurysms
Neovascularization Neovascularization
Retinal Retinal
Subretinal Subretinal
Angioma Angioma
Retinoblastoma Retinoblastoma
MicroaneurysmsMicroaneurysms
Hemangioma Hemangioma Melanoma Melanoma MetastasesMetastases
Hypofluorescence Hypofluorescence
Transmission Decrease
(blocking effect)
Transmission Decrease
(blocking effect)
Filling defect
(delay and occlusion)
Filling defect
(delay and occlusion)
Hypofluorescence Hypofluorescence Transmissionc
Decrease (blocked)
TransmissioncDecrease (blocked)
Pigment Pigment
Exudates
Exudates
Edema and
transudate
Edema and
transudate
Other abnormal materials
Other abnormal materials
Melanin Melanin Hemoglobin Hemoglobin
Xanthophyll Xanthophyll
LipofuscinLipofuscin
HardHard
Soft Soft
Best`s disease Best`s disease Foreign bodyForeign body
Fundus flavimaculatusFundus flavimaculatus
Hypofluorescence
Hypofluorescence
Filling defect (delay and occlusion)
Filling defect (delay and occlusion)
Retinal Retinal
Subretinal Subretinal
Artery Artery
VeinVein
Capillary bed Capillary bed
Loss of tissueLoss of tissue
NonperfusionNonperfusion
DystrophiesDystrophies
DegenerationDegeneration
ChoroideremiaChoroideremia
Choroidal atrophy etc.Choroidal atrophy etc.
Myopia Myopia
Central areolar atrophy Central areolar atrophy
• Retinal vascular disorders• Macular disorders• Tumors• O.N. lesions• Other fundus lesions• Iris fluorescein angiography
FFA
Not all abnormal conditions of the ocular fundus will produce abnormal fluorescein angiograms.
FFA
Things to rememberThings to remember
Thank You For Your Attention!
N شكرًا
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