interoduction to fundus fluorecein angiography

2. . Mohamed Abdel-Aziz, M.Sc
Mataryia teaching hospital

3. FFA
Fluorescence:
is the property of certain
molecules to emit light of
a longer wavelength when
stimulated by light of a
shorter wavelength.

4. FFA
Characteristics of Fluorescein
Alkaline solution
Highly fluorescent
Absorbs blue light (490 nm)
Emits yellow-green (530nm)
Removal from blood by kidneys and liver within
24-48 hrs.
injection of 5 cc of 10% Na Fl, or 3 cc of 25%
solution

5. FFA
Hazards
Minimal relatively safe drug
Temporary tan skin color
Fl. Urine discoloration
Transient nausea and vomiting
Laryngeal edema
Rarely – Syncope, resp. or Cardiac arrest
Rx – I.V. Cortisone
A physician in the 1st few minutes

6. Anatomic Considerations

7. FFA

8. 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

9. FFA
Filters
1.Blue excitation filter
2.Yellow-green filter

10. Angiographic phases

11. FFA
: Angiographic phases
Five angiographic phases:
• Pre arterial (choroidal 9-15 seconds)
• Arterial
• Arteriovenous(capillary)
• Venous
• Recirculation

12. 1-Choroidal flush 2-Arterial phase

13. 3-Arteriovenous phase

14. 4-Venous phase
Mid Phase Late Phase

15. Interpretation of FA

16. Systematic approach to reporting
angiograms
a- Patient's age and gender.
b-Right or left eyes.
c-Comment on any color and red free images.
d -Timing of filling, especially arm-to-eye
transit time.
e-Briefly scan through the sequence of images

18. FFA
Red-free fundus photos
Normal appearance Autofluorescence

19. Abnormal angiographic findings
Hypofluorescence:
Filling defect
Blocking defect
Hyperfluorescence :
window defect
Leakage
Pooling
Staining