Ocular Disease III: Lecture 2: Flourescein Angiography

Question 1

1. What is the FA assessing?

a. How is the FA captured?

Answer 1

1. Choroid, RPE, Retina, ONH, Macular and Vascular Abnormalities
   a. Thru a series of Photos after Injecting IV SODIUM FLUORESCEIN

Question 2

Principles of Fluorescence

1. Max stimulation at what light?
2. Emits what kind of light?
3. How long does it take NaFl to reach the CRA after injection?

Answer 2

1. Blue
2. Yellow-Green
3. 10-15 seconds

Question 3

What are the 2 MOST COMMON ISSUES/Concerns w/FA?

Answer 3

1. Skin Color Change AND Urine Discoloration

* Extravasations (and Skin Necrosis): Due to a Phlebotomist NOT KNOWING what they’re DOING!

Question 4

What are the CI’s for FA? (6): KNOW THEM!!

Answer 4

1. Any history of ALLERGY to DYE, IODINE, and SHELLFISH
2. Previous Anaphylaxis to FA
3. First Trimester of PREGNANCY
4. Severe Renal Impairment
5. Recent CVA, MI, Unstable Angina
6. History of HEART Disease, Arrythmia.
   * PACEMAKERS ARE NOT Complications (will be a test question!!)

Question 5

Angiogram Phases

1. What are the Six Phases?

Answer 5

1. Choroidal Flush (Early Choroidal Filling)
   (Don’t get it with Stardgart’s Disease)
2. Arterial Phase (Retinal Arterial Filling)
3. Laminar Flow (Early Venous Filling)
4. A/V Phase (Full Arteriovenous Filling)
5. Late Venous Phase (Retinal Venous Phase)
6. Late Arteriovenous Recirculation

Question 6

Normal Fluorescein Angiogram

1. At 10 SECONDS, what is seen?

Answer 6

1. CHOROIDAL FLUSH (Background Choroidal Fluorescence)

Question 7

Hypofluorescence

1. Blockage: What 4 things will cause it?
2. Filling Deficits: What will happen?

Answer 7

1. BLOOD, MELANIN, lipid (exudates: YOU CANT SEE THRU THE LIPID!! and you can’t laser them!), fibrous tissue (Tractional Retinal Detachment: DO NOT ORDER FA. You know what it is…Eye is done…Game Over)
2. Nonperfusion (ischemia)

Question 8

Hyperfluorescence (Preinjection Fluorescence)

1. Pseudo Fluorescence
2. Autofluorescence (All fluoresce w/o Injection)

Answer 8

1. Processing Problem

2. Optic Disc Drusen; Fibrous Tissue; Sclera; Tumors (Astrocytic Hamartomas) (Lipofuscin also autofluoresces!)

Question 9

Hyperfluorescence

1. Transmitted Fluorescence
   a. What 2 things?
2. **Really. What Hyperfluoresce?

Answer 9

1. a. WINDOW DEFECTS (RPE (melanin) and Retina (xanthophylls)

and

ATROPHY

2. Preinjection Fluorescence, Transmitted Fluorescence, Abnormal Vessels, Vascular Leakage

Question 10

Vascular Leakage

1. 3 things

Answer 10

1. Cystic (Macula)
2. Diffuse
3. Pooling
   a. Sub RPE
   b. Sub Retinal

Question 11

Abnormal Vessels

1. What 5 things?

Answer 11

1. A-V Anastomosis
2. Collaterals (Shunts)
3. IRMA
4. Neovascularization
5. Telangiectatic

Question 12

What 3 reasons would you NOT Perform IV FA?

Answer 12

1. Known Pathology
2. Stable Pathology
3. Significant Hemorrhage