Fundus flourescein angiography (FFA) by optometry fans. Fundus flourescein angiography (FFA) is a valuable procedure in ophthalmic practice to the diagnosis and management of a large number of fundus disorders. FFA provide information by allowing the examiner to study the changes, produced by various fundus disorders, in the flow of fluorescein dye along the vasculature of the retina and choroid indication Diabetic retinopathy Vascular occlusions Eales’ disease Central serous retinopathy (CSR) Cystoid macular oedema (CME) Contraindication Cardiac disease Renal impairment Uncontrolled hypertension Pregnancy Allergic reaction Injecting 5 ml of 10 per cent solution of sterile sodium fluorescein dye in the antecubital vein Taking serial photographs (with fundus camera) of the fundus of the patient with pupils fully dilated. The first photograph is taken after 5 seconds, then every second for next 20 seconds and every 3-5 seconds for next one minute. The last pictures are taken after 10 minutes. The fundus camera has a mechanism to use blue light (420-490 nm wavelength) for exciting the fluorescein present in blood vessels and to use yellow-green filter for receiving the fluorescent light (510-530 nm wavelength) back for photography.

1. Fundus Flourescein Angiography
(FFA)
Optometry Fans
www.optometry.fans

2. What is FFA ?
• Fundus flourescein angiography (FFA) is a
valuable procedure in ophthalmic practice to
the diagnosis and management of a large
number of fundus disorders.
• FFA provide information by allowing the
examiner to study the changes, produced by
various fundus disorders, in the flow of
fluorescein dye along the vasculature of the
retina and choroid

3. Indication
• Diabetic retinopathy
• Vascular occlusions
• Eales’ disease
• Central serous retinopathy (CSR)
• Cystoid macular oedema (CME)

4. Cotraindications
• Cardiac disease
• Renal impairment
• Uncontrolled hypertension
• Pregnancy
• Allergic reaction

5. Technique and Procedure
• Injecting 5 ml of 10 per cent solution of sterile
sodium fluorescein dye in the antecubital vein
• Taking serial photographs (with fundus camera)
of the fundus of the patient with pupils fully
dilated.
• The first photograph is taken after 5 seconds, then
every second for next 20 seconds and every 3-5
seconds for next one minute. The last pictures are
taken after 10 minutes.

6. • The fundus camera has a mechanism to use
blue light (420-490 nm wavelength) for
exciting the fluorescein present in blood
vessels and to use yellow-green filter for
receiving the fluorescent light (510-530 nm
wavelength) back for photography.

7. Complications
• FFA is comparatively a safe procedure
• Minor side effects include: discoloration of
skin and urine, mild nausea and rarely
vomiting.
• Anaphylaxis or cardiorespiratory problems are
extremely rare.

8. Phase of Angiogram
Normal angiogram consists of following phases
• Pre- arterial Phases
• Arterial Phase
• Arterio-venous phase
• Venous phase

9. Pre- arterial Phases
• Since the dye reaches the choroidal circulation
1 second earlier than the retinal arteries,
therefore in this stage choroidal circulation is
filling, without any dye in retinal arteries.

10. Arterial Phase
• It starts 1 second after pre-arterial phase and
lasts until the retinal arterioles are completely
filled.

11. Arterio-venous phase
• It starts 1 second after prearterial phase and
lasts until the retinal arterioles are completely
filled.

12. Venous phase
• In this phase, veins are filling and arterioles
are emptying.
• This phase can be subdivided into
• Early venous phase
• Mid venous phase
• Late venous phase

14. Abnormalities detected by FFA
• In the blood fluorescein is readily bound to
the albumin.
• Normally the dye remains confined to the
intravascular space due to the barriers formed
by the tight junctions between the endothelial
cells of retinal capillaries and that between
the pigment epithelial cells.

15. Abnormalities detected by FFA
• In diseased states abnormalities in the form of
hyperfluorescence and hypofluorescence may
be detected on FFA.
• Hyperfluorescence
• Hypofluorescence

16. Hyperfluorescence
• A window defect in RPE due to atrophy shows
background choroidal fluorescence.
• Pooling of dye under detached RPE.
• Pooling of dye under sensory retina after
breakdown of the outer blood-retinal barrier as
occurs in cent
• Leakage of dye into the neurosensory retina due
to a breakdown in inner blood-retinal barrier e.g.,
as seen in cystoid macular edema , central serous
retinopathy (CSR).

17. Hyperfluorescence
• Leakage of dye from the choroidal or retinal
neovascularization e.g., as seen in cases of
proliferative diabetic retinopathy, and
subretinal neovascular membrane in age-
related macular degeneration.
• Staining i.e., long retention of dye by some
tissues e.g., as seen in the presence of drusen.
• Leakage of dye from optic nerve head as seen
in papilloedema

22. Hypofluorescence
• Blockage of background fluorescence due to
abnormal deposits on retina e.g., as seen due to
the presence of retinal haemorrhage, hard
exudates and pigmented clumps.
• Occlusion of retinal or choroidal vasculature, e.g.,
as seen in central retinal artery occlusion and
occlusion of capillaries in diabetic retinopathy.
• Loss of vasculature as occurs in patients with
choroideremia and myopic degeneration.