This presentation tells about the principles of FFA, properties of fluorescein, side effects of fluorescein, technique of FFA, the anatomy behind the appearance of FFA in normal eyes
The normal FFA depends upon the retinal barriers and pigmentationin RPE which is highlighted in this talk
DR WANI'S TALK ON Optical coherence tomography of posterior segment FOR KLE ...vbwani
This presentation gives info about 1) History of OCT
2)basics of OCT
3) how it differs from USB scan
4) generations of OCT
5)how the posterior segment OCT is captured
6)normal retina and its layers on the OCT,
7) what abnormalities to look for OCT
8) common retinal diseases and their OCT appearance
DR WANI'S TALK ON Retina anatomy for PGs 2022.pptxvbwani
This is a detailed power point presentation about anatomy of Retina for post graduate students.
Deals with anatomy, structure, cell types, organization of retinal cells, structure of macula, blood supply of retina, number of rods and cones etc
DR WANI'S TALK ON Fundus fluorescein angiography PART II for post graduates.pptvbwani
This presentation talks about abnormal fluorescein angiograph
The causes of hypo flourescence and hyper fluorescence are dealth with in this presentation.
Each condition is illustrated with appropriate images of the FFA.
DR WANI'S TALK ON Optical coherence tomography of posterior segment FOR KLE ...vbwani
This presentation gives info about 1) History of OCT
2)basics of OCT
3) how it differs from USB scan
4) generations of OCT
5)how the posterior segment OCT is captured
6)normal retina and its layers on the OCT,
7) what abnormalities to look for OCT
8) common retinal diseases and their OCT appearance
DR WANI'S TALK ON Retina anatomy for PGs 2022.pptxvbwani
This is a detailed power point presentation about anatomy of Retina for post graduate students.
Deals with anatomy, structure, cell types, organization of retinal cells, structure of macula, blood supply of retina, number of rods and cones etc
DR WANI'S TALK ON Fundus fluorescein angiography PART II for post graduates.pptvbwani
This presentation talks about abnormal fluorescein angiograph
The causes of hypo flourescence and hyper fluorescence are dealth with in this presentation.
Each condition is illustrated with appropriate images of the FFA.
The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber.
The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound.
Cataract surgery has gone beyond just being a means to get the lens out of the eye.
Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery.
The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber.
The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound.
Cataract surgery has gone beyond just being a means to get the lens out of the eye.
Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery.
If the cornea is under 400 micron CXL cannot be performed safely.
The use of a hydrophilic contact lens adds 120 microns of corneal thickness and permits the treatment .
Fluorescein angiography, fluorescent angiography, or fundus fluorescein angiography is a technique for examining the circulation of the retina and choroid using a fluorescent dye and a specialized angiographic camera.
Pigment epithelial defect and intraretinal fluidLoknath Goswami
A simple and informative presentation on PED & IRF with pathophysiology, clinical examination, diagnostic imaging and one case study each for both PED & IRF
DR WANI'S TALK ON Diabetic Retinopathy Part II december 31 2022 for KLE RES...vbwani
This part iI of DR deals with DME, investigations, treatment options and prognosis in detail
DME also deals with treatment protocols and regimen.
This along with part I is meant for those who want to have in depth knowledge about DR
RETINOPATHY OF PREMATURITY FOR PEDIATRICIANSvbwani
A TALK on Retinopathy of Prematurity (ROP) mainly for pediatricians
THE POWERPOINT presentation describes the important diseaee ofROP KEEPING in view teh responsibilities of neonatologists and pediatricians.
Which babies are to be screened and when should they be referred for ROP screening are described.
It describes the criteria for screening for ROP, screening regimen, when to treat what are the complications, different methods of treatment an their rationale is described .
DR VIVEK WANI TALK ON DIABETIC RETINOPATHY FOR KLE MBBS STUDENTS UG KAHER.pptxvbwani
this talk is for MBBS STUDENTS
It gives a summary of diabetic retinopahty including epidemiology, signs and symptoms, pathogenesis , diagnosis, investigations and treatment .
it is fairly brief lecture to make UGs aware of the entity of DR
with lot of images it is a good teaching presentation.
DR WANI'S TALK ON AMD FOR RESIDENTS 30 March 2020.pptxvbwani
This contains a detailed talk on AMD given in 2020 So slightly old But basic facts remain same It deals with epedemilogy, pathogenesis, risk factors, clincial features, investigations, treatment studies on treatment etc
DR WANI'S TALK ON RETINAL DETACHMENT LECTURE FOR RESIDENTS [DR WANI TALK.pptxvbwani
Dr Wani talks on RD for residents in KLE hospital
This is a detailed talk that deals with all aspects fo RH RD
This talk aims to clear the concepts about RD
It deals the incidence of RH Rd, pathogenesis, cliinical features , diagnosis , treatment options prognosis etc
DR WANI'S TALK ON CRVO FOR RESIDENTS KLE 14 JAN 2023.pptxvbwani
This detailed talk about central retinal vein occlusion deals with all aspects of the disease
It deals with incidence and prevalence, risk factors and clinical features
It also deals with classification, importance of recognizing the ischemic type and the means to recognize it .
It deals with historical studies that gave nformation abour natural course and treatment options
sEveral studies that were conducted to treat CRVO are dealt with in which emphasis is given to anti VEGF drugs
DR WANI'S TALK ON DIABETIC RETINOPATHY PART I FOR KLE RESIDENTS.pptxvbwani
part I of detailed talk on diabetic retinopathy
covers epidemilogy , risk factors pathogenesis , classification, clinical features in detail
The presentation has lot of pictures
The presentation is based on studies published regaring each topic
It deatls with each clinical sign in detail
It also deals with risk factors for DR with examples of studies conducted
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
2. 61 yrs old, DV left eye 5 days,20/25
pseudophakic since one yr no CX in phaco sx
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 2
3. FFA tells the story
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 3
4. OCT reinforces the diagnosis
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 4
5. Objectives of this talk
• At the end of lecture you should be able to know
-what is fluorescence
-how do we do the FFA procedure
-side effects of fluorescein
-what are blood retinal barriers and how they
decide FFA
-What is normal fluorescein angiography its
phases
-What are hypo and what is hyperfluorescence
-
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 5
6. What is FFA
• It is a diagnostic fundus photography
done in rapid sequence after we give
intravenous injection of fluorescein dye
• It provides information regarding
retinal circulation
choroidal circulation
integrity of outer and inner retinal barriers
6
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
7. History
• 1871- Baeyer Synthesized - Sodium fluorescein
• 1959- Flocks -retinal circulation in cats after IV inj
of Sodium Fl
• 1960- MacLean and Maumenee studied choroidal
tumors on slit lamp with cobalt filter
•1961- First fluorescein angiography in
humans by Novotni and Alvis both
were medical students
7
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
8. What Is Fluorescence
Fluorescence is a property
of a substance to reach a
higher level of energy
after being excited by
light and then
immediately emit light and
return to the original level
of energy
The exciting light is of
shorter wavelength
(higher energy) than the
emitted light-Stokes law
of fluorescence
DR. VIVEK WANI KLE PG TALK FFA 8
24 TH SEPTEMBER 2022
9. What dye is used in FFA ?
Sodium fluorescein –
• yellowish red dye with
• molecular weight of 367.7 daltons-C20H10
O5 Na2
• Exciting light is blue light 465-490nm -485
nm peak wave length in human blood
• The emitted light is of 520-530nm
wavelength(green –yellow light) peak
wavelength 525 in human blood
9
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
10. How Do We Get Blue Light
•So a blue filter is placed in the path of
the flash light –white light- of camera
and hence only blue light enters the
eye (excitation filter)
•The blue light excites the fluorescein
in the fundus
10
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
11. 11
DR. VIVEK WANI KLE PG TALK FFA
From Kanski text book
24 TH SEPTEMBER 2022
12. How Do We Get Green Light in the
camera
• The green light is emitted by excited Fl molecules
in retina and choroid
AND
• Some amount of blue light is reflected from retina
Both lights come out of the pupil to enter the
camera
• A green filter –Barrier filter -is placed in front of
the film to allow only green light to hit the film or
digital screen of camera
12
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
13. 13
DR. VIVEK WANI KLE PG TALK FFA
From Kanski text book
24 TH SEPTEMBER 2022
17. Why Sodium Fluorescein
• Easily synthesized, cheap and relatively
inert
• Highly water soluble
• Its maximum fluorescence is at the blood
pH of 7.4
• The molecular size is large and does not
escape out of retinal capillaries and
between the RPE cells –It respects both
barriers
17
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
18. From Kanski text book
18
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
19. Why Sodium Fluorescein
While in blood the dye has
•peak excitation at 485nm
•peak emission at 525nm
•helps in using different filters to
separate the two effectively
19
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
20. What are other uses of Na fluorescein in
Ophthalmology
• Applanation tonometry
• To study ocular surface -corneal ulcers,
abrasions, or other epithelial defects
• Tear film breakup time
• Check the fit of contact lenses
• Verify the patency of lacrimal passageways
• Detect leakage of aqueous humor from corneal or
conjunctival wounds using the Seidel Test
20
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
21. Disadvantages Of Fluorescein
• It is bound in the blood to albumin
up to 80%
• Only 20% is available as free
fluorescein for FFA
PHOTOGRAPHY
• Choroidal circulation is difficult to
study because of diffuse leakage
from the choriocapillaris
• RPE pigments block the
fluorescence from choroid
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 21
22. Which drug do we use to study choroidal
circulation?
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 22
23. Drug metabolism
• The dye is metabolized in the liver and
kidney
• Eliminated in urine in 24-36 hours
• Discoloration of urine, conjunctiva and skin
are seen in all patients
• Skin coloration for 6-12 hours(avoid
sunlight)
• Urine ( orange )for 24 hours
23
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
24. Toxicity
• Mild ( 5-8% of patients)
1. Nausea
2. Vomiting
3. Pruritis
24
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
25. Toxicity
• Moderate ( 1 in 62 patients)
1. Pyrexia
2. Urticaria
3. Syncope
4. Local tissue reactions –
thrombophlebitis,, extravasation –
necrosis, neuritis
25
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
27. Toxicity
• Severe --CARSD
1. Cardiac ( myocardial infarction,
cardiac arrest)
2. Anaphylactic shock
3. Respiratory( bronchospasm,
laryngeal edema)
4. Seizures
5. Death (1:221,781)
27
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
28. What precautions should be in place?
• IV line
• O2
• Inj.Hydrocortisone, adrenaline, antihistamine, IV fluids
• Cardiopulmonary resuscitation
CONTRAINDICATIONS
• Known allergy to Fluorescein
• Allergy to shell fish, iodine
• Unstable angina, recent MI, recent stroke, severe renal
impairment, pregnancy first trimester?
• SO ASK HISTORY !
28
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
29. Indications
• It is mainly a diagnostic tool
• Use when FFA can make difference in diagnosis or therapy
• Where baseline data is needed –study or long term FU
29
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
30. Examples of indications
• Macular disorders –CNV, hereditary disorders, DME, ME due to RVO,
CSR, uveitis
• Wet AMD -CNV- FFA is gold standard for diagnosis
• Macular edema due to DR –specifically to rule out ischemia
• Hereditary retino-choroidal disorders –Stargardt’s, cone rod
dystrophy, RP etc
• CME-uveitis
• CRVO, BRVO-to classify ischemic from non ischemic, diagnose CME
• CSR- if treatment is contemplated to identify the site of leak to laser
• Retinal tumors or choroidal tumors- may have specific patterns to aid
diagnosis
• ROP – identifies new vessels and abnormalities at periphery -
RETCAM
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 30
31. The Technique
• Informed consent-MUST
• Dilatation of pupils is must
• Take IV line
• Patient at the camera, focus and take
color photographs
red free photographs and
pre-injection photograph with filters on
• IV injection of 5 ml of 10% sodium fl or 3 ml of 25%
• Take photographs from 7 sec to 40 seconds every second
• Then late photographs are taken usually after 2, 5,
20minutes
31
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
33. Oral Fluorescein Angiography
Is indicated in cases where IV is impossible or
hazardous
• Quality of photographs- not good
• 1gm of Fl( 10 ml of 10%) mixed with orange juice
to mask the taste
• Photos are taken 20 minutes and later
• All the phases of FFA cannot be studied
• Only pooling or staining can be studied
• Severe allergic reactions can still occur but
nausea and vomiting are rare
33
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
34. INTERPRETATION OF FFA
Three basic facts decide the
appearance of the FFA
A. Inner blood retinal barrier –tight junctions
between endothelial cells of retinal vessels do
not allow Fl molecules to escape from them in
to the retinal extravascular space
So any extravascular Fl in the retina is
abnormal
34
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
35. Second basic fact- that decides the appearance of the FFA
B. Outer retinal barrier – the RPE cells have
zonula occludensa between them which do
not permit Fl molecules to escape from
chorio-capillaris in to the subretinal space
So any Fl in the subretinal space is
abnormal
DR. VIVEK WANI KLE PG TALK FFA 35
24 TH SEPTEMBER 2022
37. From Kansky text book
37
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
38. C. RPE contain melanin pigments which partially filter the
fluorescence of the choroidal vasculature(choriocapillaris
leak Fl molecules normally because of fenestrated
endothelium)
The brightness of choroidal vasculature depends upon
pigmentation in RPE and in diseases that cause atrophy of RPE or
hypertrophy of RPE
Retina is transparent and only xanthophyll in macula acts
as a partial filter
DR. VIVEK WANI KLE PG TALK FFA 38
Third basic fact to decide the appearance of the FFA
24 TH SEPTEMBER 2022
39. From Duanes text book
39
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
40. Field of area photographed
• Usually about 45-60 d
• So many times peripheral pathologies are not imaged
properly
• So ultrawide field FFA has come
• 200d field
• OPTOS
24 TH SEPTEMBER 2022 DR. VIVEK WANI KLE PG TALK FFA 40
42. Normal Findings of FFA
I. Prefilling phase( pre-injection phase)
II. Transit phase
a) Choroidal phase
b) Arterial phase
c) Arterio-venous phase
d) Venous phase
III. Re-circulation
IV. Late phase(Elimination phase)
42
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
43. I. Prefilling Phase
• Photographs are taken with the filters placed and
before the dye is injected
• This helps to rule out pseudo fluorescence and
auto-fluorescence
• Pseudo-fluorescence is due to mismatching of
filters or decay in filters
• Auto-fluorescence is natural fluorescence of
some materials in the eye
• Seen with --Optic nerve drusen, astrocytic
hamartomas, lipofuscin pigments-drusens in the
retina, Best’s vitelliform and the aging human lens
43
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
45. II. Transit Phase
• The first complete passage of the dye through
choroidal and retinal circulations(artery,
capillaries and veins)
• Normally within the first 30 seconds of the
injection
• Subdivided into
a) Pre-arterial OR choroidal
b) Arterial
c) Arteriovenous and
d) Venous phase
45
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
46. II) (a) Pre-arterial OR Choroidal Phase
• As choroid is nearer than retina for blood
circulation, fluorescein appears in choroid
one second earlier
• Choroid fills in a segmental and patchy
filling
• It is due to the lobular arrangement of the
chorio-capillaris
• The appearance of dye in choroid is known
as choroidal flush
46
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
53. II.(a) Pre-arterial phase or Choroidal
Phase
• If cilioretinal artery + it fills up at the same
time
• Less pigmented fundus will show brighter
choroidal fl
53
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
55. II. Transit phase (b)Arterial Phase
• First appearance of the dye in the retinal
arteries marks the beginning of this phase
• Lasts till the dye fills up the arterial tree and
dye appears in capillaries- retinal
background fl
• The “arm to retina” time is the interval
between the injection of dye and its
appearance in retinal artery at the disc
• Normally 11-15seconds
• Delayed in – cardiac failure, carotid block,
Temporal arteritis, CRAO etc
55
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
56. 56
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
57. I. Transit phase (c) Arterio-venous Phase
• Brief phase of retinal capillaries filling up
• Starts from filling up of retinal capillaries till first
evidence of laminar filling of the veins is seen
• The capillary filling gives the background
fluorescence seen in the retina
• It starts obscuring the choroidal flush to certain
extent
• Capillary fill up is seen best in the macular area
because of the background of dark RPE
57
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
58. 58
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
59. Choroidal flush and retinal backgroud fluorescence add together
to make bright retina
DR. VIVEK WANI KLE PG TALK FFA 59
24 TH SEPTEMBER 2022
60. II.(d) Venous Phase
• Starts when the lamellar flow is seen in
veins
• Lamellar flow is due to the blood reaching
sides of the veins first and non-turbulent
flow
• In 5-15 seconds the veins fill completely
and appear brighter than arteries
• When the veins fill completely the phase
ends
60
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
61. 61
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
64. 64
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
65. III. Recirculation Phase
• Occurs when blood returns to the eye after complete
circulation of the dye
• This usually occurs after 30 seconds after the injection
and lasts up to 3 minutes
• Fluorescence decreases in vessels as the concentration
of dye becomes less bcs it is uniformly distributed in the
tissues in the body
• Artery and veins are equally bright
• The contrast also is less due to staining of choroidal
tissues
• Leakage and staining start in this phase
65
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
66. 66
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
67. IV. Late Phase
• Begins after 15 minutes of injection
• The retinal and choroidal vessels appear only
faintly
• Background fl due to choroidal and scleral
staining is seen
• ONH staining is seen
• Vitreous and aqueous leakage is seen
• Abnormal fl like pooling in spaces is seen in this
phase
67
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
69. 69
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
70. 70
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022
71. Special areas-Macula
• No capillaries in the fovea
• Lutein pigments-block choroidal fl-where
are they?
• Tall RPE with more pigments also block
choroidal fl
• It remains dark till the end
71
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
72. Macula
• From Duanes text book
DR. VIVEK WANI KLE PG TALK FFA 72
24 TH SEPTEMBER 2022
74. Optic Disc
•ONH lights up with choroidal stage
•Further filling in arterial stage
•No leakage over the disc
•Peripapillary scleral staining is
common
74
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
77. IVF
I ) Preinjection phase
II) Transit phase which is divided into
a) Choroidal or prearterial
b) Arterial
c) Capillary or arteriovenous
d) Venous
III) Recirculation phase
IV) Late phase
77
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
78. THANK YOU
END OF PART I
78
DR. VIVEK WANI KLE PG TALK FFA
24 TH SEPTEMBER 2022
79. 79
DR. VIVEK WANI KLE PG TALK FFA
Dr.Vivek Wani
24 TH SEPTEMBER 2022