Fundus Fluorescein Angiography (FFA) is a technique that uses a fluorescent dye and specialized camera to examine the circulation of the retina and choroid. It works by injecting fluorescein sodium dye intravenously, then visualizing its passage through the retinal and choroidal blood vessels using blue light to excite the dye and yellow-green light to detect its emission. FFA is used to detect early vascular pathologies, confirm diagnoses of various retinal conditions like macular degeneration, diabetic retinopathy, and choroiditis by revealing areas of hypofluorescence from blockages and hyperfluorescence from abnormal vessels or leakage. While generally safe, rare adverse reactions from the dye including nausea, vomiting, and

1. Fundus Fluorescein
Angiography
Vasiur Rahman
Phase-III

2. FFA
• technique for examining the circulation of
the retina and choroid using a fluorescent
dye and a specialized camera.

3. Purpose
• Highlight retinal and choroidal circulation
• Detect early vascular pathologies
• Confirm diagnosis

4. How does it work?
Charateristics applications
• Absorbs 465-490nm,
emits 520-530nm
• Binding to plasma
proteins, esp Albumin
• Selective visualization of
its passage
• Confined to natural blood
retinal barrier

5. • Based on luminescence.
– Fluorescence
– phosphorescence
• Exciter filter
– Allows only blue light to illuminate
retina(wavelength of 490 nm)
• Barrier filter
– Allows only yellow-green light (from the
fluorescence) to reach the camera
wavelength 525 nm)
P

6. Dosage and Administration
• It is performed by injecting fluorescein
sodium dye as a bolus into a peripheral
vein. The normal adult dosage is 500mg,
and is typically packaged in doses of 5 ml
of 10% or 2 ml of 25%.

7. The sequence:
passage of dye after inj.
Visualization
• 10 to 15 sec : Short posterior ciliary arteries.
• Choroidal flush, optic nerve head, cilioretinal
artery.
• 11-18 sec: Retinal circulatiion, arteries-capillaries-
veins.
• 20-25 sec: juxtrafoveal and perifoveal capillaries
Maximal fluorescence around FAZ. The best time
for PEAK PHASE IMAGING.
• 30 sec: First passage completed. Recirculation
starts
• After 10min: total disappearance of dye.

8. • A. (preinjection) With exciter and barrier in place, the
featureless black control photograph reveals either
the presence or absence of auto- and
pseudofluorescence.
• B. (0 secs after injection) The tran-sit phase begins
with choroidal filling.
• C. (10 secs) Described as patchy, the transit phase is
simultaneous with the filling of cilio-retinal arteries

9. • D. (12 secs) The retinal arteries are infused.
• E. (15 secs) The dye returns via the retinal
veins. Note the laminar flow during the
arteriovenous phase
• F. (about 30 secs) The angiogram is brightest
and microvasculature most visible.

10. • G–I. (5 and 10 mins) As the fluorescein
dye diffuses through the tissue, contrast
decreases and the optic nerve head stain

11. The Interpretation
Hypo-fluorescenceHyper-fluorescence
• Blocked: Media opacity,
Hem
• Vascular Filling Defects:
Occlusions, capillary non
perfusion
• Autofluorescence
• Transmitted fluorescence
• Hyperfluorescence:
• 1. Abnormal Vessels:
Angiomas, Tumours
• 2. Leakage:
• 3. Pooling: CSR, PED
• 4. Staining: Disc, drusen,
chorioret. scar

12. Transmitted fluorescence
Window defect
Tearing of RPE

13. Diabetic retinopathy

14. Macular degeneration
• (A) Color
• (B) red-free
• (C) photgraphs of a
fundus with soft
drusen and
hyperpigmentation.
Soft drusen
hyperfluoresce during
the early phase of
angiography (D)stain
in the late phase

15. choroiditis
• Red-free photo, early
arteriovenous phase, peak phase ,
and late phase angiogram of a left
eye with choroiditis. Early
angiogram demonstrates
hypofluorescence of the choroidal
lesions with the development of
circumferential hyperfluorescence
and leakage in the later stages of
the angiogram.

16. Central Serous
retinopathy
Color fundus photograph
(A) and corresponding
fluorescein angiography
images,
(B) early, (C) mid, (D) late
phase
showing ink blot type of
RPE leak

18. • Fluorescein angiogram showing
intense hyperfluorescence created by
the window defect after a retinal
pigment epithelial tear. The
hypofluorescence corresponds to the
area where the pigment epithelium
rolled together in accordion fashion

19. BRVO
Late arteriovenous phase
demonstrates leakage from the
supertemporal retinal vessels
Late arteriovenous or laminar
venous phase angiogram in a
patient with a superotemporal
branch retinal vein occlusion.
Hypofluorescence is noted along
the superotemporal arcade

20. CRVO

21. Be aware-
• nausea, vomiting, acute hypotension,
anaphylaxis
• Cardiac arrest
• Death
• The most common adverse reaction is
nausea, due to a difference in the pH
• 25 times higher if the person has had a prior
adverse reaction
• The risk can be reduced with prior
(prophylactic) use of antihistamines

22. • Premedication with promethazine
hydrochloride or proclorperazine may
prevent or lessen the severity of nausea
and vomiting in patients with a history of
previous reactions to fluorescein
• Extravasation

23. • pruritus or urticaria can be treated with
antihistamines
• More severe reactions are rare, but
include laryngeal edema, bronchospasm,
anaphylaxis, tonic-clonic seizure,
myocardial infarction and cardiac arrest.
The overall risk of death from fluorescein
angiography has been reported as 1 in
222,000.
Yannuzzi LA, Rohrer KT, Tindel LJ, et al. Fluorescein angiography complication survey. Ophthalmology 93:611-617, 1986.

24. During Pregnancy and
Lactation
• Controversial
• Fl. Crosses the placenta
• Has been done in pregnancy with
no adverse effect
• Do it when necessary