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Fluorescein angiography is commonly used in evaluation of retinopathy. Adverse reactions are uncommon but severe cardiovascular difficulties seem to occur selectively in older men with hypertension and ischemic heart disease. The 54-year-old patient described had hypertensive crisis and resulting myocardial infarction after fluorescein angiography.
Fluorescein angiography was used to study retinal microvascular perfusion in 20 patients undergoing coronary artery surgery. Colour retinal photographs and fluorescein angiograms were obtained preoperatively and at 5-14 days postoperatively. In 10 patients retinal fluorescein angiograms were also obtained intraoperatively during cardiopulmonary bypass, and all were found to have retinal microvascular occlusions after 40-160 min of extracorporeal circulation. 3 patients had in addition focal leakage of fluorescein, and 6 had foci of abnormal drainage of dye. These changes are consistent with retinal microembolism, and appeared to have resolved by the time of the postoperative study. No new pathological features appeared in the retina after surgery. Intraoperative fluorescein angiography of the retina may prove valuable for investigation of cerebrovascular microembolism in the territory of the internal carotid artery during cardiopulmonary bypass in man.
Fluorescein angiography is undertaken to investigate the state of the circulation in diabetic eye disease, the commonest manifestation of which is diabetic retinopathy. Senior ophthalmic nurses, equipped with the appropriate skills and level of confidence, are now undertaking the procedure. In the eye centre at the Central Middlesex Hospital, a proactive nurse-led approach to the management of patients undergoing fluorescein angiography has had a significant impact on the outcomes of the procedure, and resulted in positive patient feedback.
Fluorescein angiography is a recently developed method of studying the tympanic membrane's dynamic vasculature. Our preliminary studies using an ophthalmic fundus camera and aural speculum did not always permit visualization of the entire tympanic membrane, and the electronic flash unit used in our initial studies did not cycle fast enough to visualize effectively the rapid arterial phase of blood flow. In this report, we describe an endoscopic method of tympanic membrane fluorescein angiography that uses a continuous xenon light source. A representative angiogram from a normal subject is described. The mallear artery apparently is the major blood supply to the posterior half of the tympanic membrane, which is consistently better perfused than the anterior half. Branches from the annular ring of blood vessels supply the anterior half of the tympanic membrane. Preliminary studies of two temporalis fascia tympanoplasty patients indicate that the graft becomes revascularized 2 to 4 weeks after surgery and that posterior grafts may revascularize earlier than anterior grafts.
PURPOSE: The purpose of the study is to disclose the nature of fluorescent dots and segments traditionally observed with fluorescein angiography (FA) using a scanning laser ophthalmoscope (SLO 101; Rodenstock, München, Germany). The authors developed a new method, called fluorescein leukocyte angiography (FLA), to display directly the movement of leukocytes in human retinal vessels. METHODS: Fluorescein angiography was performed on two normal volunteers using a scanning laser ophthalmoscope and fluorescent dots and segments were observed. Fluorescein leukocyte angiography, using an injection of fluorescent buffy coat layer from which the fluorescent plasma and nonfluorescent erythrocytes have been removed externally, was performed on seven normal volunteers. Injection fluid smears were examined through a fluorescent microscope. Peripheral blood smears taken during midphase of FA and FLA also were examined. In addition, 15 early-phase FAs of central serous chorioretinitis (CSC) were studied retrospectively. RESULTS: In the FAs of normal volunteers, fluorescent dots were detected only in perimacular capillaries at early phase. Eight of the 15 CSC FAs examined showed both fluorescent dots and segments. In the FLAs, fluorescent dots were detected in whole retinal vessels for more than 30 minutes. Fluorescent segments were observed in FA but not in FLA. Injected fluid smears from one FLA showed fluorescent leukocytes and small platelets. However, in peripheral blood smears of the FLA, leukocytes and platelets were more visible and exhibited higher contrast than those of an FA due to background plasma fluorescence. The mean velocity of 21 flowing leukocytes in perifoveal capillaries was 1.37 +/- 0.35 mm/second in 2 FAs and that of 89 flowing leukocytes was 1.41 +/- 0.29 mm/second in 7 FLAs. CONCLUSIONS: The authors' observations suggest that fluorescent dots in scanning laser ophthalmoscope imaging are fluorescein-stained leukocytes, whereas fluorescent segments are the hyperfluorescent plasma that is located between rouleaux formations of erythrocytes. The velocity of the fluorescent dots could be measured in the perimacular capillaries by either FA or FLA; however, only FLA can display the flow of fluorescent leukocytes in large vessels.
Fluorescein angiography was performed in 12 hemispheres of eight young patients with moyamoya disease to study the epicerebral microcirculation. Regional circulation time and the time interval between carotid injection of the dye and first filling of the cortical arteries were various and prolonged in the most parts. There were nonfilling areas by carotid injection of the dye in six hemispheres. By venous injection, the dye appeared in all vessels of the exposed areas. Extravasation of the dye was seen in four hemispheres. The degree of these abnormalities of the epicerebral microcirculation was well correlated with the findings in conventional cerebral angiography.
Fluorescein angiography of the ocular fundus has become a primary diagnostic tool in ophthalmology. It can be of great value in patients with visual loss without ophthalmoscopic abnormality.
Fluorescein angiography is a common diagnostic procedure. Questions have been frequently raised as to whether explicit informed consent is needed for this procedure and what form such consent should take. Review of existing legal concepts indicates that the need for explicit consent varies from state to state, but that the trend is to require an explicit discussion of risks, benefits, and alternatives. Documentation of such information can adequately range from a brief, written notation in the patient's chart to a complete, separate form.
Indocyanine-green angiography and fluorescein angiography may complement each other in the follow-up and evaluation of choroidal melanomas treated with brachytherapy and may give a better understanding in the process of response of choroidal melanomas to brachytherapie. We did a retrospective study on 18 patients treated for this pathology.
BACKGROUND: The vascularisation features of intraocular tumours may be characterised by indocyanine green angiography (ICG-A) and fluorescein angiography (FA). Proton beam irradiation is an established method of treating malignant melanoma of the choroid. The aim of this study was to describe the vascularisation features of small choroidal melanomas and to examine the influence of proton beam irradiation on these tumours. METHODS: We examined 39 choroidal melanomas by ICG-A and FA from 1998 to 2001 in a prospective study. The tumours had a mean prominence of 3.65 mm (1.2-7.5 mm) and a common feature of all was their parapapillary or paramacular localisation. Angiography was always performed immediately before proton beam radiotherapy and at intervals of 3 months, half a year and 1 year thereafter. Two hundred and forty angiographies were analysed in total. RESULTS: Intra-tumoral vessels could be visualised in 89% of all tumours by ICG angiography but in only 33% by FA. Neither ICG-A nor FA detected changes 3 months after irradiation; however, ICG-A disclosed strong leakage from vessels in the tumour area after 6 months. These changes increased markedly after 12 months and were also visible by FA. A disadvantage of FA, however, was the faster escape of dye from the vessels, which caused rapid leakage in the tumour area and meant that details could no longer be demonstrated. CONCLUSIONS: ICG-A and FA detect marked vascular changes within the tumours examined.
Patients underwent intracapsular cataract extraction and implantation of a Choyce Mk IX anterior chamber intraocular lens. At fluorescein angiography (FAG) at a mean of 8 months post-operatively, 9 showed leaking from the iridal vessels, and 3 were normal: Three cases were excluded because of factors affecting the iris FAG. At a mean of 37 months 5 still had a slight degree of leakage. No primarily negative iris FAG changed to positive later. Fluorescein gonioscopic photography (FGP) revealed leakage in 29.5% of the tips of the foot plates at a mean of 37 months. No correlation was observable between FGP and gonioscopy. The pupillary deformation quotient DQ (greatest: smallest pupillary diameter) was significantly greater at a mean of 8 months in the eyes with leakage in iris FAG than in eyes without leakage (P = 0.0145). Individually a change both in direction against normalisation and in elongation was recorded during the observation time.
Fluorescein angiography (FA), which implies that the tissue is reproduced in natural size, and fluorescence microscopy was compared in anesthetized normovolemic and hypovolemic rats in order to define the microscopic background to the fluorescence pattern obtained by FA. It was found that the fluorescence detected by FA by the use of sodium fluorescein as an indicator substance was emitted from the interstitial and intracellular compartments, including the intranuclear. Microscopy showed that sodium fluorescein was located extravascularly in the small intestine within 4 seconds after an intravenous injection. There was a 4 second interval between corresponding microscopic and macroscopic fluorescence pattern.
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PURPOSE: Fluorescein angiography is routinely used in ophthalmologic practice with minimal changes in vision reported by the patient after the procedure. Recent animal work has suggested that fluorescein may be cytotoxic in the presence of light and may cause retinal damage. The authors examined whether any changes occur in foveal vision function after fluorescein angiography. METHODS: A battery of tests of vision function--including visual acuity, contrast sensitivity, color vision, and two-color increment thresholds designed to isolate individual cone pathways--was administered before and 48 hours after fluorescein angiography to a group of 10 patients with good visual acuity. RESULTS: Most of the patients showed significant abnormalities with the nonstandard tests; however, no significant changes in central vision function were found 48 hours after fluorescein angiography. CONCLUSION: Even sensitive vision tests show no measurable effect of fluorescein angiography on foveal vision function in eyes with significant disease.
BACKGROUND: Fluorescein angiography is often beneficial in the evaluation and management of many retinal vascular diseases. However, vitreous blood or opacities may prevent fluorescein studies before pars plana vitrectomy. After vitrectomy, fluorescein angiography may be delayed, creating uncertainty over differentiation of preoperative, intraoperative, and postoperative findings. METHODS: The authors have modified an intraocular light source and operating microscope to perform intraoperative fluorescein angiography easily. Twenty-five patients underwent fluorescein angiography during pars plana vitrectomy. All studies were recorded using a microscope-mounted video camera for intraoperative and postoperative evaluation. RESULTS: In all cases, intraoperative angiography was performed without complication. Indications for intraoperative studies included confirmation of macular edema, delineation of avascular retina, and localization of retinal and choroidal neovascularization. All videotape recordings of procedures were of high quality, allowing easy review and interpretation. CONCLUSION: Intraoperative fluorescein angiography is an easily performed adjunctive diagnostic procedure that can aid intraoperative evaluation and treatment of selected retinal vascular disorders.
PURPOSE: To report the efficacy and safety of fluorescein angiography after oral administration of fluorescein solution in a large number of patients during a period of 8 years. METHODS: A total of 1,787 patients (2,625 eyes) underwent fluorescein angiography after oral administration of sodium fluorescein at Hara Eye Hospital, Utsunomiya, Japan, between January 1989 and March 1997. The ingestible solution was 10 ml of 10% sodium fluorescein, the same material generally used for injection in conventional fluorescein angiography. Retinal photography began 15 minutes after ingestion and continued for 1 hour. The camera and the photography and film processing techniques were the same as those used for conventional fluorescein angiography using injected sodium fluorescein. RESULTS: In 2,554 (97.3%) of 2,625 eyes, photographs adequate for clinical use were obtained. In 1,787 patients, no anaphylactic or other severe adverse effects were observed, and only 31 patients (1.7%) experienced minimal itching, discomfort, or nausea after oral sodium fluorescein intake. For conditions such as central serous chorioretinopathy, retinal vein occlusion, diabetic retinopathy, and cystoid macular edema, sufficient information for clinical use was obtained. CONCLUSIONS: Fluorescein angiography using orally administered sodium fluorescein is generally effective and safe in standard clinical practice.