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Published on : Mar 14, 2014
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Slide 3 - Introduction To Fluorescein Angiography Saleh A. Al Amro, FRCS Head of Retina – Vitreous Division KSU
Slide 4 - Described in 1959 by MacLean and Maumenee IV FAA or oral FFA Angiography or Angioscopy Emergency kit FFA
Slide 5 - 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
Slide 6 - 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
Slide 7 - During Pregnancy and Lactation Controversial Fl. Crosses the placenta Has been done in pregnancy with no adverse effect Do it when necessary FFA
Slide 8 - 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
Slide 9 - 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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Slide 11 - 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
Slide 12 - 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
Slide 13 - 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
Slide 14 - Angiographic Analysis Sequential Anatomic Morphologic Be systematic – comment on the choroid, retina, disc and macula FFA
Slide 15 - Normal Arm-to-retina circulation time is 12-15 sec. Five angiographic phases: Pre arterial Arterial Arteriovenous Venous Recirculation FFA
Slide 16 - 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
Slide 17 - Hyperfluorescence Leak Transmission increase Abnormal vessels
Slide 18 - Leak Pooling (in a space) Staining (in a tissue). Pigment epithelial window defect Retinal Subretinal Tumors Abnormal Vessels Transmission increase
Slide 19 - 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
Slide 20 - Hyperfluorescence Transmission Increase Pigment Epithelial Window Defect Atrophy Drusen
Slide 21 - 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
Slide 22 - Hypofluorescence Transmission Decrease (blocking effect) Filling defect (delay and occlusion)
Slide 23 - Hypofluorescence TransmissioncDecrease (blocked) Pigment Exudates Edema and transudate Other abnormal materials Melanin Hemoglobin Xanthophyll Lipofuscin Hard Soft Best`s disease Foreign body Fundus flavimaculatus
Slide 24 - 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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Slide 77 - Retinal vascular disorders Macular disorders Tumors O.N. lesions Other fundus lesions Iris fluorescein angiography FFA
Slide 78 - Not all abnormal conditions of the ocular fundus will produce abnormal fluorescein angiograms. FFA Things to remember
Slide 79 - Thank You For Your Attention! شكراً