Angiography, fluorescein

Rapid sequence fluorescein angiography shows leakage in the neovascular form... 

A few cases of advanced cystoid macular edema have been reported in the older literature these took months to resolve once nicotinic acid was withdrawn (SEDA-14, 331 SEDA-20, 191 15,20). Four new cases have been added in patients who took nicotinic acid 2-4.5 g/day (21,22). The first symptoms of blurred vision appeared 1-18 months after the start of therapy. Withdrawal of nicotinic acid resulted in improvement of visual acuity and resolution of the cystoid macular edema within 1-2 months. A particular feature that distinguishes this form of maculopathy is the absence of leakage on fluorescein angiography. Retinal edema, when it occurs, will abate on withdrawal of nicotinic acid (15). 

A 28-year-old woman with a long history of psychiatric problems was taking fluoxetine, diazepam, methylphe-nidate, and thioridazine 800 mg qds (17). Fluorescein angiography showed confluent areas of punctate hyperfluorescence, consistent with diffuse retinal pigment epithelial alteration secondary to acute thioridazine toxic effects. 

The introduction of fluorescein angiography in the early 1960s provided a useful method for studying various parameters of ocular function. Intravenous fluorescein is used extensively to delineate vascular abnormalities of the fundus and occasionally to evaluate anterior segment blood and aqueous flow. 

Chapter 31 discusses the clinical procedure and interpretation of fluorescein angiography. 

Intravenous ICG has proven essentially as safe as sodium fluorescein. Few toxic effects have occurred, but severe allergic reactions have been reported. In one study ICG was generally well tolerated and caused fewer reactions than did fluorescein. However, two patients developed hives, and one experienced transient nausea and vomiting. In another series it was found that the near-infrared illumination of the technique was more comfortable than that used in fluorescein angiography. Patients did not experience nausea or other adverse effects from ICG. Because ICG remains bound to proteins in the blood and is rapidly metabolized by the liver, discoloration of the urine, skin, or mucous membranes does not occur. 

D Anna SA, Hochheimer BE, Joondeph HC, Graebner KE. Fluorescein angiography in the heavily pigmented iris and new dyes for iris angiography. Arch Ophthalmol 1983 101 289-293. 

HaraT, Inami M, HaraT. Efficacy and safety of fluorescein angiography with orally administered sodium fluorescein. Am J Opthalmol 1998 126 560-564. 

Kwan ASL, Barry C, McAlhster IL, Constable 1. Fluorescein angiography and adverse drug reactions revisited the Lions Eye Experience. Chn Exp Ophthalmol 2006 34 33-38. 

Kwiterovich K, Maguire MG, Murphy RP, et al. Frequency of adverse systemic reactions after fluorescein angiography results of a prospective study. Ophthalmology 1S>91 98 1139-1142. 

Meyer PAR,Watson PG. Low dose fluorescein angiography of the conjunctiva and episclera. Br J Ophthalmol 1987 72 2-10. 

Morgan KS, Franklin RM. Oral fluorescein angiography in aphakic children. J Pediatr Ophthalmol Strabis 1984 21 33-36. 

DIAGNOSTIC TESTS FOR RETINAL DISEASE FLUORESCEIN ANGIOGRAPHY ... 

Fluorescein angiography reveals subtleties in vasculature not readily apparent with ophthalmoscopy or fundus biomicroscopy. The two diseases most often evaluated angiographically are macular degeneration and diabetic retinopathy. 

For fluorescein angiography a properly equipped fundus camera must have a high-intensity flash system combined with a rapid recycle time, power winding, appropriate excitation filters (the Baird Atomic B2 470 or Kodak Wratten 47), and barrier filters (an Ilford 1109 Delta Chromatic 3 or Kodak Wratten G15).Both excitation and... 

ICGA is most valuable for evaluation of choroidal neovascularization. Fluorescein angiography of early choroidal fluorescence is potentially inhibited by media opacities, fundus pigmentation, xanthophyll, RPE, hemorrhage, or serous exudate in the retina. Rapid leakage from the fenestrated choroidal capillaries is sometimes not easily appreciated with fluorescein angiography in attempting to identify subretinal CNVMs. 

Butner RW, McPherson AR. Adverse reactions in fluorescein angiography.Ann Ophthalmol 1983 15 1084. 

Halperin LS, Oik RJ, Soubrabe G, et al. Safety of fluorescein angiography during pregnancy. Am J Ophthalmol 1990 109 563. 

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