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FLUORESCEIN ANGIOGRAPHY presentation in ophthalmology
- 1. FLUORESCEIN ANGIOGRAPHY Group 5 Presenter :YOHANA RAPHAEL
- 2. introduction • Fluorescein isa synthetic organic compound available as a dark orange /red powder soluble in water and alcohol • It can be prepared from phthalic anhydride and resorcinol in the presence of zinc chloride via the friedel – crafts reaction
- 3. principle • Fluorescence –property of the certain molecules to emit energy of longer wave length when stimulated by ashorter wavelength • Absorbs light in the blue range at 465- 490 nm • Emits light of yellow – green range of visible spectrum peaking at 520-530nm
- 4. Equipment for fluoresceinangiography • Fundus camera ( 20- 35 -50 degrees ) with digital imaging system • Matched fluorescein filters (barriers and filters ) • 23-G scalp vein needle • 5ml syringe • 5ml of 10% fluorescein solution • Tourniquet • Alcohol swab • Standard emergency equipment
- 5. Dyes used inAngiography Sodium fluorescein Indocyanine green
- 6. Sodium fluoroscein • Diabasicacid , yellow red in color • Stable, highly water soluble & pharmacologically inert • Low molecular weight 376.27 D • Fluoresces at blood ph • Peak absorption 465-490nm • Peak emission – 520- 530 nm • 80 % bound to plasma protein and also with RBC • Cant pass through tight retinal barriers so allows study of retinal circulation
- 7. advantages • Cant passthrough tight retinal barriers so allows study of retinal circulation Disadvantage • Cant study choroidal circulation
- 8. Flourescein solutions • 10mlof 5% (500mg) • 5ml of 10% (500mg ) • 3ml of 25% (750mg )
- 9. Indocyanin Green • Greendye that fluoresces with visible infrared light • It specially usefull for studying the deeper choroidal circulation • Safe for general use and less toxic than sodium fluorescein • Needs special type of fundus camera
- 10. CLEARANCE • Within 24hours • Mainly urine ( yellow orange coloration • Small amount –bile • Some absorbed by kidney • Skin staining may remain up to 24hrs • Urine discoloration 24- 36 hours
- 11. Dosage • 10% solutionof 5ml • 25 % solution of 3ml ( for opaque media ) • Solution above 25% precipitates
- 12. indication • Retinal vasculardisorders • Macula disorders • Optic nerve disorders • Choroidal disorders • Retinal vascular malformation and tumor
- 13. Retinal vascular disorder,malformation and tumors
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- 15. Choroidal lesions 1) Choroidalneovascular membrane 2) Hemangioma 3) Nevus 4) Melanoma 5) Choroiditis 6) Metastasis 7) Choroidal folds
- 16. Optic nerve disorders 1)Optic atrophy 2) Papilloedema 3) Ischaemic optic neuropathy 4) Optic disc pit 5) Optic disc drusen 6) Optic disc haemangioma 7) Melanocytoma 8) Myelinated nerve fibers
- 17. Contraindication • Absolute 1) Knownallergy to iodine containing compounds 2) h/o adverse reaction to FFA in the past Relative 3) Asthma 4) hay fever 5) Renal failure 6) Hepatic failure 7) Pregnancy ( especially 1st trimester
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- 20. procedure • Patients isinformed of the normal procedures , the side effects and the adverse reactions • Dilating the pupil • Made to sit comfortable • 3-4 red free photographs (c0ntrol photographs ) • 5ml of 10% or 3ml of 25% NAF injected through the antecubital vein • Wait for 10-12 secs ( normal retina time ) • Then every 2 seconds interval for 30 secs • Late photographs are usually taken after 3,5and 10 mins
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- 22. Types of circulationin fundus
- 23. Phases of normalangiogram • Preaterial phase (choroid phase) • Arterial phase • Artrio venous phase • Venous phase • Early venous • Mid venous • Late venous • Late phase
- 24. Choroidal phase • 10-12 seconds after dye injection • Initial patchy filling followed by diffuse filling • No dye has entered retinal circulation
- 25. Arterial phase • Showsarterial filling • Continuation of choroidal filling • 1 second after choroidal phase
- 26. Arterio- venous phase •Complete filling of arteries and capillaries • Early laminar flow to veins • Dye seen along lateral wall of veins
- 27. Venous phase • Earlyvenous phase • Arteries and capillaries completely filled • Marked lamellar venous flow
- 28. Mid venous phase •Some veins completely filled • Some shows marked laminar flow
- 29. Late venous phase •All veins completely filled • Arteries begin to empty
- 30. Late /elimination phase •Elimination of dye from choroidal and retinal circulation • Staining of disc – normal • In 5- 10 mins fluorescein absent from angiogram
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- 33. Increased accumulation ofdye Leakage • Papilledema • CNV • Breaking of inner blood retinal barrier • Retinal neovascularization • Proliuferative retinal diabetic
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- 38. hypofluorescence • Reducton orabsence of fluorescein
- 39. Blocked fluorescence examplesare • Pre- retinal lesions eg vitreous opacity , preretinal haemmorrhage block all fluorescence • Deep retinal lesions • Increased density of RPE eg congenital hypertrophy • Choroidal lesions eg naevus
- 40. Examples of fillingdefects • Avascular occlusion of choroidal circulation or retinal arteries , veins and capillaries • Loss of vascular bed eg severe myopic degeneration – choroieremia • Emboli • arteriosclerosis
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- 45. LIMITATIONS OF FFA 1)Does not permit study of choroidal circulation details due to 2) More adverse reaction 3) Inability to obtain angiogram in patient with excess hemoglobin or serum proteins eg 1) Polycythemia 2) Weldenstrom macroglobulanaemia –because binding of fluorescein with exces Hb or protein so , lack of freely circulating molecule
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