This document provides information about fluorescein angiography (FA), including: 1. FA involves injecting fluorescein dye and using filters to view the retinal and choroidal circulation as the dye enters and leaves blood vessels. 2. There are five angiographic phases visible - choroidal flush, arterial, arteriovenous, venous, and recirculation. 3. Abnormalities seen on FA include hypofluorescence (filling defects and blocking defects) and hyperfluorescence (window defects, leakage, pooling, and staining). These provide information about conditions affecting the retinal and choroidal vasculature and barriers.

3. Mohamed Abdel-Aziz (MSc,ICO,Egyption Board)
Mataryia Teaching Hospital

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

5. 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
FFA

6. 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
FFA

7. Anatomic Considerations

8. FFA

9. General principles of FA
Fluorescein
• 85% bound to serum proteins
• 15% unbound ‘free’ fluorescein
• Impermeable to fluorescein
Outer blood-retinal
barrier (zonula occludens)
• Impermeable to fluorescein
Choriocapillaris
• Permeable only to ‘free’ fluorescein
Inner blood-retinal barrier
(retinal capillaries)

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

11. Angiographic phases

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

13. 1-Choroidal flush 2-Arterial phase

14. 3-Arteriovenous phase

15. 4-Venous phase
Mid Phase Late Phase

16. Interpretation of FA

17. Red-free fundus photos
Normal appearance Autofluorescence
FFA

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

19. Hypofluorescence

20. Filling defect
 Inadequate perfusion of tissue (e.g:Vascular occlusion, Loss of the
vascular bed )

21. Blocking defect
 Masking of retinal fluorescence(e.g:intraretinal haemorrhages )
 Masking of background choroidal fluorescence (e.g:naevi)

22. Hyperfluorescence

23. window defect
 Atrophy or absence of the RPE .e.g: as in atrophic age-
related macular degeneration, full-thickness macular holes

24. Pooling
 breakdown of the outer blood–retinal barrier (RPE tight
junctions)
 A) In the sub-retinal space: increases in intensity and
area, the maximum extent remaining relatively well-
defined.(e.g:CSR)

25. Pooling
 B ) In the sub-RPE space: early hyper-fluorescence which
increases in intensity but not in size .(e.g:PED)

26. Leakage
 early hyper-fluorescence which increases in both area and
intensity
 A) Dysfunction or loss of existing vascular endothelial
tight junctions(e.g:CME)

27. Leakage
 B) Primary absence of vascular endothelial tight
junctions (e.g:CNV,PDR)

28. Staining
 prolonged retention of dye in tissue(e.g:drusen,
exposed sclera )

29. 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