DR WANI'S TALK ON Fundus fluorescein angiography PART II for post graduates.ppt

ABNORMAL FLUORESCEIN
ANGIOGRAM
Dr.Vivek B. Wani MS FRCSEd
Consultant (Vitreoretina)
KLES Dr. Prabhakar Kore Hospital and MRC
Belgaum

What is abnormal FFA?
If we do not find
• Normal amount of dye at the expected level
of time
• Normal amount of dye at the expected level
of tissue
THEN WE SAY THAT THERE IS ABNORMAL
FLUORESCENCE
FFA part II BY DR. WANI
24TH SEPTEMBER 2022 2

How to read FFA
•Always keep color fundus photograph
for interpretation
•IVF is a dynamic process-so one
frame may not tell the whole story
•Serial Frames should be examined to
determine the pathology

Abnormal Fluorescence
Two types
I) Hypo-fluorescence-less than normal
fl
II) Hyper-fluorescence –more than
normal fl

I) Hypo-Fluorescence
There are two reasons for hypo fluorescence
Either something blocks the fl that is present normally so we
don’t see it
A- Blocked Fl
Blocking material can be pigments (Hb, melanin,
xanthophyll), exudates, edema, flecks or FB
Or
B- Filling defect
there is no fluorescein in the tissues where it must be
present -- due to loss of vessels -
Filling defect—closure of retinal or choroidal vessels

Hypo-fluorescence –Blocked fluorescence
• Which circulation is blocked by the blocking
material?
• Retinal or choroidal or both?
• Blocking depends upon the location of the
blocking material
• It is important to read a color photograph or red-
free photograph to correlate area of blocked fl
with the material blocking the fl

Blocked Fl due to pigment-HB
Which circulation is not seen here (blocked here)?
Dr.Vivek Wani Dr.Vivek Wani

Blocked fl due to -----blood -hb
Which circulation is not seen here (blocked here)?

Blocked Fl due to subretinal material
which circulation is blocked here?
Dr.Vivek Wani
Dr.Vivek Wani

Blocked Fl-Hard exudate- mainly the
choroidal circulation is blocked

Blocked Fl-melanin pigment
Dr.Vivek Wani
Dr.Vivek Wani

Blocked Fl-Melanin
Dr.Vivek Wani
Dr.Vivek Wani

Blocked Fl-Xanthophyll pigment in macula
Dr.Vivek Wani
Dr.Vivek Wani

Hypo fluorescence -Filling defect
• Delay or Occlusion of blood flow
• Retinal- Artery, vein or capillaries
• Choroidal tissue- loss of choroidal tissue – dystrophy or
degeneration
Important to rule out blocked fl in the area of hypo fl that
there is no material blocking the fl and it is due to filling
defect

Filling defect –retinal artery

Filling defect vein
Dr.Vivek Wani

Vein filling defect and ?
Dr.Vivek Wani

Retinal capillary drop out areas
Dr.Vivek Wani
Dr.Vivek Wani

24TH SEPTEMBER 2022 FFA part II BY DR. WANI 20

Capillary drop out areas
Dr.Vivek Wani
Dr.Vivek Wani

Dr.Vivek Wani

Hypo-fluorescence –choroidal circulation
• Atrophy of the choroidal vasculature

Dr.Vivek Wani

CHOROIDAL VASCULAR DEFECT
Dr.Vivek Wani
Dr.Vivek Wani

Choroidal circulation filling defect

Dr.Vivek Wani

Hyper-Fluorescence
Excess fluorescein seen than expected
Leakage
Increased transmission of Fl-window defect
Abnormal vessels- Retinal, Sub-retinal and tumors

Hyper-fluorescence
• Leakage
Pooling in a space-
Retinal –CME –flower petal appearance
Sub-retinal –CSR,RPE detachment
Staining of a tissue-
Retinal –non cystoid edema or fibrovascular staining
Sub-retinal ----drusens , sclera, scars

Pooling in a space-Retinal –CME
Dr.Vivek Wani
Dr.Vivek Wani

Dr.Vivek Wani

Pooling in a space Sub-retinal
• Serous RD
• RPE detachment

Pooling in a space-Subretinal CSR
Dr.Vivek Wani
Dr.Vivek Wani

Pooling in a space-subretinal-CSR
Dr.Vivek Wani
Dr.Vivek Wani

CSR
• From Duanes

Pooling in a space-Subretinal-RPE
detachment
RPE detachment
• Because of firm adhesion
of RPE the detachment
has sharp borders unlike
serous RD
Dr.Vivek Wani

RPE detachment
Dr.Vivek Wani
Dr.Vivek Wani

RPE detachment
• The area fluoresces in Choroidal phase
• The size remains same
• The intensity increases gradually as more
fluorescein molecules accumulate
• It has sharp borders

• From duanes

Hyperfluorescence- Staining of a tissue
•Retinal – perivascular staining
•Subretinal-drusen, scars sclera

STAINING OF VEINS -VASCULITIS
Dr.Vivek Wani
Dr.Vivek Wani

Dr.Vivek Wani

Subretinal scar
Dr.Vivek Wani

Transmission Defect –RPE Window
defect
• Atrophic RPE revealing the choroidal circulation brightly –
RPE Window defect
• RPE atrophy may be due to several causes –drusen,
inflammation, hereditary diseases, trauma etc
• Hyperfl in choroidal phase in the area of atrophy
• Gradually increases in intensity
• Later the fl decreases in intensity as the dye exits the
circulation
• Some staining of the sclera is seen in late phases and
leakage from choriocapillaris at the edge of the lesion

Dr.Vivek Wani

Hyper-fluorescence-abnormal vessels
• Retinal- telengiectasia, NVE,NVD, Macroanuerysms etc
{They leak because of lack of inner BRB}
• Subretinal- CNV, Scars with vessels
• Tumors- Retinoblastoma, melanoma, hemangiomas,
secondaries

Dr.Vivek Wani

Hyperfl due to microaneurysms
Dr.Vivek Wani
Dr.Vivek Wani

Dr.Vivek Wani

Hyperfl- telengiectasia
Dr.Vivek Wani

Telengiectasia
Dr.Vivek Wani

Abnormal vessels
• Subretinal –CNV- start leaking from choroidal phase itself

Dr.Vivek Wani

CNV
Dr.Vivek Wani

CNV
Dr.Vivek Wani
Dr.Vivek Wani

Subretinal scar-some vessels may be still
leaking

Tumors choroidal melanoma
Dr.Vivek Wani

Dr.Vivek Wani

THANK YOU!

Blocked Fl-Hard Exudate
Dr.Vivek Wani
Dr.Vivek Wani

DR WANI'S TALK ON Fundus fluorescein angiography PART II for post graduates.ppt

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DR WANI'S TALK ON Fundus fluorescein angiography PART II for post graduates.ppt