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Retina > AF and ICG > Flashcards

AF and ICG Flashcards

1
Q

Excitation peak for fluorescein - nm and spectrum

A

490 nm (in the blue part of the spectrum)

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2
Q

Emission - nm and color

A

530 nm - yellow-green light

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3
Q

Excretion - where and how fast

A

in the urine over 24–36 hours

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4
Q

Colors

A

White light from the camera is filtered so that blue light enters the eye (cobalt blue excitation filter). Yellow–green barrier filter blocks any blue light reflected from the eye, allowing only yellow–green emitted light to pass.

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5
Q

Absolute contraindication

A

Fluorescein allergy

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6
Q

Relative contraindications

A

severe reaction to any allergen, renal failure, pregnancy, moderate–severe asthma, significant cardiac disease.

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7
Q

Adverse events in fluorescein angiography

A

Discoloration of skin and urine. Extravasation of injected dye, giving a painful local reaction. Nausea, vomiting. Itching, rash. Sneezing, wheezing. Vasovagal episode or syncope. Anaphylactic and anaphylactoid reactions. Myocardial infarction. Death

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8
Q

choroidal (pre-arterial) phase - when

A

9–15 seconds after dye injection

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9
Q

arterial phase - when

A

second after the onset of choroidal fluorescence

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10
Q

Maximal perifoveal capillary filling is reached at

A

around 20–25 seconds

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11
Q

Fluorescein is absent from the retinal vasculature after

A

about 10 minutes

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12
Q

Autofluorescent

A

accumulated lipofuscin in the RPE, nerve head drusen, astrocytic hamartoma

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13
Q

Window defect - when

A

atrophy or absence of the RPE, full-thickness macular hole, RPE tears and some drusen

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14
Q

Window defect - characteristics

A

very early hyperfluorescence that increases in intensity and then fades without changing size or shape

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15
Q

Pooling - pathophysiology

A

breakdown of the outer blood–retinal barrier (RPE tight junctions)

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16
Q

Pooling - when

A

subretinal space, e.g. CSR - early hyperfluorescence, slowly increases in intensity and area, the maximum extent remaining relatively well defi. sub-RPE space, as in PED - early hyperfluorescence that increases in intensity but not in size

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17
Q

Leakage

A

breakdown of the inner blood–retinal barrier due to:
○ Dysfunction or loss of existing vascular endothelial tight junctions as in background DR, RVO, CMO and papilloedema.
○ Primary absence of vascular endothelial tight junctions as in CNV, proliferative diabetic retinopathy, tumours and some vascular anomalies such as Coats disease.

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18
Q

Staining

A

late phenomenon consisting of the prolonged retention of dye in entities such as drusen, fibrous tissue, exposed sclera and the normal optic disc

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19
Q

ICGA - wavelength

A

near-infrared light

20
Q

ICGA - early

A

up to 60 seconds post-injection

21
Q

ICGA - early mid-phase

A

1–3 minutes

22
Q

ICGA - late mid-phase

A

3–15 minutes

23
Q

ICGA - late phase

A

15–45 minutes

24
Q

ICGA - contraindications

A

liver disease (excretion is hepatic), history of a severe reaction to any allergen, moderate or severe asthma and significant cardiac disease

25
Q

ICGA - Indications

A

PCV, Chronic central serous, Posterior uveitis, Choroidal tumours, Breaks in Bruch membrane such as lacquer cracks and angioid streaks, If FA is contraindicated

26
Q

Serous PED - AF

A

well demarcated oval area of hyperfluorescent pooling that increases in intensity but not in area. an indentation (notch) may signify CNV

27
Q

Serous PED - ICGA

A

oval hypofluorescent area with a surrounding hyperfluorescent ring. Occult CNV (focal hot spot or diffuse plaque) is detected in over 90%.

28
Q

Fibrovascular PED - FA

A

markedly irregular granular (stippled - punktowe) hyperfluorescence, with uneven (nierówny) filling of the PED, leakage and late staining

29
Q

Drusenoid PED - FA

A

Early diffuse hypofluorescence with patchy relatively faint early hyperfluorescence, progressing to moderate irregular late staining

30
Q

Haemorrhagic PED - FA

A

Dense masking of background fluorescence, but overlying vessels are visible

31
Q

Drusenoid PED - ICGA

A

Hypofluorescence predominates

32
Q

Retinal pigment epithelial tear - FA

A

Late phase shows hypofluorescence over the flap due to the thickened folded RPE, with adjacent hyperfluorescence, initially over the exposed choriocapillaris where the RPE is absent and later due to scleral staining

33
Q

Classic CNV - FA

A

well-defined ‘lacy’ pattern during early transit, subsequently leaking into the subretinal space over 1–2 minutes, with late staining of fibrous tissue

34
Q

Occult CNV - FA

A

its limits cannot be fully defined on FA

35
Q

RAP (retinal angiomatous proliferation) - ICGA

A

diagnostic. hot spot in mid and/or late frames and frequently a perfusing retinal arteriole and draining venule (hairpin loop)

36
Q

Ischaemic maculopathy

A

FA shows capillary non-perfusion at the fovea (an enlarged FAZ) and frequently other areas of capillary non-perfusion at the posterior pole and periphery

37
Q

Intraretinal microvascular abnormalities (IRMA) - FA

A

focal hyperfluorescence associated with adjacent areas of capillary closure (‘dropout’) but without leakage

38
Q

BRVO - FA

A

peripheral and macular ischaemia (capillary non-perfusion, staining of vessel walls, vessel ‘pruning’ – small branches failing to fill), haemorrhage and oedema with collateral vessels commonly forming in established cases. Venous filling is delayed

39
Q

Impending (partial) CRVO - FAF and FA

A

FAF may reveal a fern-like perivenular appearance, and FA generally demonstrates an impaired retinal circulation

40
Q

Non-ischaemic CRVO - FAF

A

characteristic fern-like perivenular hypoautofluorescence due to masking of background signal by oedema

41
Q

Non-ischaemic CRVO - FA

A

delayed arteriovenous transit time, masking by haemorrhage, usually good retinal capillary perfusion and some late leakage

42
Q

ischaemic CRVO - FA

A

marked delay in arteriovenous transit time, masking by retinal haemorrhages, extensive areas of capillary non-perfusion and vessel wall staining and leakage

43
Q

BRAO - FA

A

delay in arterial filling and hypofluorescence of the involved segment due to blockage of background fluorescence by retinal swelling

44
Q

Acute macular neuroretinopathy (AMN) - FA

A

normal or shows faint hypofluorescence

45
Q

Sympathetic ophthalmitis - FA

A

multiple foci of leakage at the level of the RPE, with subretinal pooling in the presence of exudative retinal detachment

46
Q

Sympathetic ophthalmitis - ICGA

A

hypofluorescent spots in active disease, which resolve with treatment

Retina (8 decks)

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