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    42fundus Angiography

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    Hitesh Sharma
    This document provides an introduction to fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography. It discusses the characteristics, principles, techniques, and normal phases of FFA and ICG angiography. It also outlines various causes of hyperfluorescence, hypofluorescence, and other abnormalities that may be detected on angiography, including retinal and choroidal pathologies. FFA uses sodium fluorescein dye while ICG angiography uses indocyanine green, which is safer and leaks less from blood vessels. Both techniques provide vital information for evaluating retinal and choroidal diseases.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    42fundus Angiography

    Uploaded by

    Hitesh Sharma
    205 views28 pages
    This document provides an introduction to fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography. It discusses the characteristics, principles, techniques, and normal phases of FFA and ICG angiography. It also outlines various causes of hyperfluorescence, hypofluorescence, and other abnormalities that may be detected on angiography, including retinal and choroidal pathologies. FFA uses sodium fluorescein dye while ICG angiography uses indocyanine green, which is safer and leaks less from blood vessels. Both techniques provide vital information for evaluating retinal and choroidal diseases.

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    42Fundus Angiography

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    This document provides an introduction to fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography. It discusses the characteristics, principles, techniques, and normal phases of FFA and ICG angiography. It also outlines various causes of hyperfluorescence, hypofluorescence, and other abnormalities that may be detected on angiography, including retinal and choroidal pathologies. FFA uses sodium fluorescein dye while ICG angiography uses indocyanine green, which is safer and leaks less from blood vessels. Both techniques provide vital information for evaluating retinal and choroidal diseases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    205 views28 pages

    42fundus Angiography

    Uploaded by

    Hitesh Sharma
    This document provides an introduction to fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography. It discusses the characteristics, principles, techniques, and normal phases of FFA and ICG angiography. It also outlines various causes of hyperfluorescence, hypofluorescence, and other abnormalities that may be detected on angiography, including retinal and choroidal pathologies. FFA uses sodium fluorescein dye while ICG angiography uses indocyanine green, which is safer and leaks less from blood vessels. Both techniques provide vital information for evaluating retinal and choroidal diseases.

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    Download as PPT, PDF, TXT or read online from Scribd
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    You are on page 1of 28

    Introduction To Fundus Fluorescein Angiography (FFA)And Indocyanine Green(ICG)

    - Dr HITESH SHARMA, JR1 , DEPT OF OPHTHALMOLOGY, IMS B.H.U.

    FUNDUS ANGIOGRAPHY
    1. Fluorescein (FA)
    Characteristics of Fluorescein & General principles Excitation and emission Filters Photographic technique Phases of normal angiogram Causes of dark appearance of fovea Causes of hyperfluorescence Causes of hypofluorescence

    2. Indocyanine green (ICG)


    General principles Phases of normal angiogram

    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.

    General principles of FA
    Fluorescein

    85% bound to serum proteins 15% unbound free fluorescein

    Inner blood-retinal barrier (retinal capillaries)

    Impermeable to fluorescein

    Outer blood-retinal barrier (zonula occludens)

    Impermeable to fluorescein

    Choriocapillaris

    Permeable only to free fluorescein

    Excitation and emission

    Filters

    Photographic technique

    1. Take red-free photograph 2. Inject rapidly 5 ml of 10% solution 3. Take photographs at 1 sec intervals between 5-25 sec after injection 4. Take photographs after 10 min and 20 min, if appropriate

    Normal FFA
    Arm-to-retina circulation time is 12-15 sec. Five angiographic phases:
    Pre arterial Arterial Arteriovenous Venous Recirculation

    Phases of normal FA

    Arterial

    Arterial filling

    Arteriovenous (capillary)

    Early venous

    Very early lamellar venous flow

    Marked lamellar venous flow

    Mid-venous

    Late venous

    Almost complete venous filling

    Complete venous filling

    Progressively weaker fluorescence Staining of disc

    Late

    Leak

    Hyperfluorescence

    Transmission increase

    Abnormal vessels

    Pooling (in a space) Leak Staining (in a tissue). Transmission increase Pigment epithelial window defect Retinal Abnormal Vessels Subretinal Tumors

    Retinal Pooling (in a space) Subretinal Hyperfluorescence Leak Retinal Staining (in a tissue). Subretinal

    Cystoid edema Sensory retina detachment Retinal pigment epithelium Noncystoid edema Perivascular staining Drusen Scars Sclera Lamina cribrosa

    Pigment Hyperfluorescence Transmission Increase Epithelial Window Defect Atrophy Drusen

    Retinal

    Tortuosity and Dilation Neovascularization Microaneurysms Aneurysms Macroaneurysms Telangiectasias Shunts and collaterals Neovascularization Vessels in scar Angioma Retinal Retinoblastoma Hemangioma Melanoma Metastases

    Hyperfluorescence

    Abnormal Vessels Subretinal

    Tumors Subretinal

    Transmission Decrease (blocking effect) Hypofluorescence

    Filling defect (delay and occlusion)

    Pigment

    Melanin Hemoglobin Xanthophyll Lipofuscin Hard Soft

    Hypofluorescence

    Transmission Decrease (blocked)

    Exudates Edema and transudate

    Other abnormal materials

    Best`s disease Foreign body Fundus flavimaculatus

    H y p o f l u o r e s c e n c e

    Artery Retinal Vein Capillary bed

    Filling defect (delay and occlusion)

    Dystrophies Loss of tissue

    Choroideremia Choroidal atrophy etc. Myopia Central areolar atrophy

    Subretinal

    Degeneration Nonperfusion

    Causes of dark appearance of fovea


    Avascularity Blockage of background choroidal fluorescence by:

    Increased density of xanthophyll Large RPE cells with more melanin

    Causes of hyperfluorescence ( 1 )
    RPE window defect Pooling of dye

    RPE atrophy
    (bulls eye maculopathy

    Under RPE
    (pigment epithelial detachment)

    (central serous retinopathy)

    Under sensory retina

    Causes of hyperfluorescence (2)


    Leakage of dye Prolonged dye retention ( staining )

    (cystoid macular oedema)

    Into sensory retina

    (choroidal neovascularization

    From new vessels

    Associated with drusen

    Causes of hypofluorescence (1)


    Blocked retinal or choroidal fluorescence

    Blood under retinal pigment epithelium

    Abnormal material Increased pigment

    Preretinal or intraretinal blood

    Causes of hypofluorescence (2)


    Vascular occlusion Loss of vascular tissue

    Capillary non-perfusion (venous occlusion)

    Choroideremia or high myopia

    Side Effects
    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 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

    During Pregnancy and Lactation


    Controversial Fl. Crosses the placenta Has been done in pregnancy with no adverse effect Do it when necessary

    General Principles of ICG Angiography


    1. Binding

    98% bound to proteins Less leakage from choriocapillaris Much less than fluorescein Excitation peak 800 nm Emission at 835 nm Infrared barrier and excitation

    2. Fluorescence

    3. Filters

    4. Safer than fluorescein

    Phases of normal ICG angiogram (1)


    Early (20 sec) Early middle (3 min)

    Disc hypofluorescence Poor perfusion of vertical (watershed) zone near disc Prominent filling of choroidal arteries Early filling of choroidal veins Filling of retinal arteries but not veins

    Filling of watershed zone Fading of choroidal arterial filling Prominent filling of choroidal veins Filling of retinal arteries and veins

    Phases of normal ICG angiogram (2)


    Late middle (6 min) Late (21 min)

    Reduced filling of choroidal vessels Diffuse hyperfluorescence due to diffusion of dye from choriocapillaris Persistent filling of retinal vessels

    Large choroidal and retinal vessels are empty Diffuse background hyperfluorescence

    FFA

    Things to remember Not all abnormal conditions of the ocular fundus will produce abnormal fluorescein angiograms.

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