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FFA ppt.pptx
- 1. D R .G . N A G E S W AR R A O ; M D A S S O . P R O F. O P H T H A L M O L O G Y, K I M S V I T R E O - R E T I N A L S U R G E O N Fundus fluorescein angiography
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- 3. LUMINESCENCE & fluorescence Luminescence:- Emission of light from any source other than high temperature It occurs when energy in the form of electromagnetic radiation is absorbed and then re-emitted at another frequency Fluorescence:- luminescence that is maintained only by continuous excitation
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- 6. Purpose of ffa studying the normal physiology of the retinal and choroidal circulation,as well as disease process affecting the macula. Evaluation of the vascular integrity of the retinal and choroidal vessels Check the integrity of the blood ocular barrier. - outer blood retinal barrier breaks in CSR - inner blood retinal barrier breaks in NVD,NVE
- 7. Therefore , it helps: In clinical diagnosis to determine extent of damage To formulate treatment strategy for choroidal and retinal disease To monitor result of treatment
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- 9. Retinal diseases 1) Diabeticretinopathy 2) Retinal vein occlusions 3) Retinal artery occlusion 4) Retinal vasculitis 5) Coats disease 6) Familial exudative vitreoretinopathy Macular diseases 1) Central serous retinopathy 2) RPE detachment 3) Cystoid macular edema 4) Macular hole 5) ARMD 6) Cone rod dystrophy 7) Epiretinal membrane 8) Vitiliform dystrophies 9) Stargardts dystrophy
- 10. contraindications ABSOLUTE 1) known allergyto iodine containing compounds. 2) H/O adverse reaction to FFA in the past. RELATIVE 1) Asthma 2) Hay fever 3) Renal failure 4) Hepatic failure 5) Pregnancy ( especially 1st trimester)
- 11. Adverse effects MILD MODERATESEVERE Staining of skin, sclera and mucous membrane Nausea and vomiting Respiratory- laryngeal edema ,bhroncospasm Stained secretion Tear, saliva Vasovagal response Circulatory shock, MI, cardiac arrest Vision tinged with yellow urticaria Generalized convulsion Orange-yellow urine fainting Skin necrosis Skin flushing, tingling lips pruritus
- 12. PROCEDURE Patient is informedof the normal procedures, the side effects and the adverse reactions. Dilating the pupil Made to sit comfortable. 3-4 red free photographs taken. (control photographs) 5ml of 10% or 3ml of 25% NAF injected through the anticubital vein
- 13. wait for 10– 12 seconds( normal arm-retina time) Photos are taken at 1 second interval for 10 seconds Then every 2 seconds interval for 30 seconds Late photographs are usually taken after 3 ,5 and 10 minutes.
- 14. CIRCULATION OF DYE Dyeinjected from peripheral vein venous circulation heart arterial system INTERNAL CAROTID ARTERY Ophthalmic artery Short posterior ciliary artery) Central retinal (choroidal circulation.) ( retinal circulation) N.B. The choroidal filling is 1 second prior to the retinal filling.
- 16. what is normalangiography?
- 17. Two types ofcirculation in fundus A.Choroidal circulation -choriocapillaries are fenestrated -so allows dye to diffuse freely BUT, -outer blood-retinal barrier in RPE don’t let dye to reach retina B.Retinal circulation -endothelial cells of retinal blood vessels joined by tight junctions (inner blood retinal barrier) -prevents leakage of dye from vessels
- 18. Phases of angiogram A)Choroidal (pre-arterial) B) Arterial C) iovenous(capillary) D) Venous and E) Late(elimination) Patchy filling No leakage No complication WHY ???
- 20. Prearterial/choroidal phase 8-12seconds after dye injection Initial patchy filling followed by diffuse filling No dye has entered retinal circulation
- 21. Arterial phase Showsarterial filling Continuation of choroidal filling 1 second after choridal phase
- 22. Arterio-venous phase(capillary phase) Complete filling of arteries and capillaries Early laminar flow to veins Dye seen along lateral wall of veins
- 23. Early venous phase Arteries and capillaries completely filled Marked lamellar venous flow
- 24. Mid-venous phase Someveins completely filled Some shows marked laminar flow
- 25. Late venous phase All veins completely filled Arteries begin to empty
- 26. Late/elimination phase Eliminationof dye from choroidal and retinal circulation Staining of disc – normal In 5-10 minutes fluorescein absent from angiogram And from body in several hours
- 27. Fovea in FFA Appears dark AVASCULARI TY IN FAZ BLOCKAGE OF CHOROIDAL FLUORESCENCE INCREASED XANTHOPHYL L PIGMENTS LARGER RPE CELLS WITH MORE MELANIN
- 28. Hypofluorescenc e (black) patch Hyperfluorescen ce(white) patch
- 29. FFA interpretation flowchart Fluorescein angiogram Normal Abnormal Artifact Hyperfluorescence Hypofluorescence Leakage Pooling Staining Window Blocked Nonfilling defect filling
- 30. hyperflourescence Greater levelof fluorescence than would be found in normal angiogram Occur due to: -window defect -increased accumulation of dye leakage pooling staining
- 31. examples Papilledema Abnormalchoroidal vasculature(CNV) Breaking of inner blood retinal barrier(cystoid macular oedema) Abnormal retinal or disc vasculature(retinal neovascularization) Proliferative Diabetic Retinopathy(NVD,NVE)
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- 33. Neovascularization at disc(NVD) Neovascularizationelsewhere (NVE)
- 34. pooling Accumulation offluorescein in anatomical space Due to breakdown of outer blood retinal barrier
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- 36. staining Accumulation offluorescence within a tissue Due to prolonged dye retention Minimum hyperfluorescence in early and midphase which increases in late phase Can be seen in normal as well as pathologically altered tissue
- 37. examples RETINAL a. non-cystoid macular oedema b.Perivascular staining SUB RETINAL a. Drusens b. Sclera c. Lamina cribrosa d. scars
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- 39. hypofluorescence Reduction orabsence of fluorescein Two causes BLOCKED FLUORESCENCE VASCULAR FILLING DEFECTS
- 40. BLOCKED FLUORESCENCE Opticalobstruction (masking) of normal density of fluorescein Caused by lesions anterior to retina
- 41. examples Pre-retinal lesionseg.vitreous opacity,preretinal haemorrhage block all fluorescence Deep retinal lesions eg.intraretinal haemorrhage and hard exudates block only capillary fluorescence Increased density of RPE eg.congenital hypertrophy Choroidal lesions eg.naevus
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- 43. Filling defects Inadequateperfusion of tissue with resultant low fluorescein content
- 44. examples vascular occlusionof choroidal circulation or retinal arteries,veins and capillaries Loss of vascular bed eg.severe myopic degeneration – choroideremia Emboli arteriosclerosis
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- 46. Zonula occludents openup normal Endothelial cell is lost Pores in endothelial cells
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- 50. RETINAL PIGMENT EPITHELIUM Normal RPE is tight zonula occludens seal portion of all the intercellular spaces of the pigment epithelial monolayer.
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- 54. summary Even todayFFA, has its position in the diagnosis of retinal diseases Normal retinal vessels will not leak dye Hypofluorescence – blocked/filling defect always match with red free fundus photo Hyperfluorescence – leakage of dye from abnormal vasculature/collection of the dye into an extracellular space Wide field angiogram – recent advancement
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