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F. Kianersi MD 1390 / 4 / 2. Sodium fluorescein (C20H10Na2) is a highly water-soluble complex organic molecule with a molecular weight of 376.27..

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Presentation on theme: "F. Kianersi MD 1390 / 4 / 2. Sodium fluorescein (C20H10Na2) is a highly water-soluble complex organic molecule with a molecular weight of 376.27.."— Presentation transcript:

1 F. Kianersi MD 1390 / 4 / 2

2 Sodium fluorescein (C20H10Na2) is a highly water-soluble complex organic molecule with a molecular weight of

3 Excitation of fluorescein occurs when it is exposed to Blue wave-lengths between 465 and 490 nm, resulting in emission of Yellow-Green frequencies (520 to 530 nm).

4 The excited Fluorescein within the Vessels and extra-cellular spaces emits Yellow-Green Fluorescent Light, which is recorded on the Photographic film.

5 5 CC of 10% Sodium Fluorescein solution is routinely given IV at the start of the procedure. Route & Dose of Administration The Fluorescein dye is injected rapidly into an Antecubital Vein.

6 Fluorescein first appears in the eye as faint patchy regions of fluorescence in the Choroid approximately 12 to 15 seconds following IV administration.

7 Normal Angiogram

8 Background Choroidal Flush The flow is directed toward the Choriocapillaris, the filling of which is called the Background Choroidal Flush.

9 Arterial Phase 1 Fluorescein dye is seen within the arterioles 1 second of the Choroidal flash.

10 Laminar Venous Phase (Early A-V Phase) As blood-borne dye crosses the capillary network and enters the venous system, a columnar appearance to the veins initially is observed.

11 Full Venous Phase (Late A-V Phase) As more fluorescein enters the veins, they fill totally.

12 Late Phase This phase shows the eventual fate of the dye.

13 Evaluation of Fluorescein Angiography 1) Hypo-Fluorescence 2) Hyper-Fluorescence

14 Hypo-Fluorescence a.Vascular Filling Defect b.Blockage

15 Hypo-Fluorescence 1. Vascular Filling Defect Carotid Artery Ophthamic Artery Retinal Vessels Capillary Bed Vessels of Optic Nerve Choroid

16 Occlusion of the Carotid Vascular Filling Defect

17 CRAO Vascular Filling Defect (Retinal Vessels)

18 BRAO Vascular Filling Defect (Retinal Vessels)

19 CRVO Vascular Filling Defect (Retinal Vessels)

20 Diabetes Vascular Filling Defect (Capillary Bed)

21 Cotton Wool Spot Vascular Filling Defect (Capillary Bed)

22 Hypo-Fluorescence 2. Blockage Pre-Retinal Intra-Retinal Sub-Retinal Different Deposits

23 Opacities of the Refractive Media and Vitreous (Pre-Retinal) Blockage

24 Pre-Retinal Hemorrhages Blockage (Pre-Retinal)

25 Melanocytoma Blockage (Pre-Retinal)

26 Hemorrhage, Blockage (Intra-Retinal)

27 RPE Hyperplasia, Blockage (Intra-Retinal Pigment)

28 Hemorrhage Blockage (Sub-Retinal)

29 (Choroidal Nevus) Blockage (Sub-Retinal Pigment)

30 Inflammation (Toxoplasmosis) Blockage (Sub-Retinal)

31 Fluid (CSR) Blockage (Sub-Retinal)

32 Best Vitelliform Degeneration Blockage (Different Deposits)

33 Hyper-Fluorescence 1)Window Defect of RPE 2)Leakage 3)Anomalous Vessels

34 1) Window Defect of RPE Hyper-Fluorescence

35 Window Defect of the RPE (Decreased Pigment in the RPE) Degenerative Myopia

36 Window Defect of the RPE (Decreased Pigment in the RPE) Albinism

37 Window Defect of the RPE (Atrophy of the RPE) Geographic, or Areolar Atrophy

38 Window Defect of the RPE Angioid Streaks

39 Window Defect of the RPE (Toxic Damage) Bull's Eye Maculopathy (Chloroquine)

40 Window Defect of the RPE (Trauma) Choroidal Ruptures

41 Hyper-Fluorescence a.Choroid b.Retina c.Optic Nerve Head 2) Anomalous Vessels

42 Anomalous Vessels CNV (Choroid)

43 Anomalous Vessels Choroidal Tumor (Melanoma) (Choroid)

44 Anomalous Vessels (Retina) Coats' Disease

45 Anomalous Vessels Collateral Vessels Venous-Venous Anastomotic (Retina)

46 Anomalous Vessels (Parafoveal Telangiectasis) (Retina)

47 Anomalous Vessels (Capillary Hemangiomas) Tumor Vessels (Retina)

48 3)Leakage a.Into Tissue Staining b.In a Preformed Space Pooling Hyper-Fluorescence

49 Leakage Into Tissue (Staining)

50 Drusen

51 Optic Disk & Sclera Leakage Into Tissue (Staining)

52 Schar Tissue (Serpiginous Choroidopathy) Leakage Into Tissue (Staining)

53 Vessel Walls Leakage Into Tissue (Staining)

54 Leakage in a Preformed Space (Pooling)

55 CSR Leakage in a Preformed Space (Pooling)

56 RPE Detachment (PED) Leakage in a Preformed Space (Pooling)

57 Inflammatory Serous Detachment (Harada Disease) Leakage in a Preformed Space (Pooling)

58 Retinal Leakage A.Cystoid Edema B.Non-Cystoid Edema

59 Cystoid Retinal Leakage

60 Retinal Teleangiectasia (Juxta-Foveal Retinal Teleangiectasia) Cystoid Retinal Leakage

61 Microaneurysms (Leber's Miliary Aneurysms) Cystoid Retinal Leakage

62 Diabetic Retinopathy Cystoid Retinal Leakage

63 Venous Occlusion (BRVO) Cystoid Retinal Leakage

64 Venous Occlusion (Non-Ischemic CRVO) Cystoid Retinal Leakage

65 Non-Cystoid Retinal Leakage

66 Arterial Hypertension Non-Cystoid Retinal Leakage

67 Vasa-Occlusive Retinal disease (BRVO) Non-Cystoid Retinal Leakage

68 Diabetic Retinopathy Non-Cystoid Retinal Leakage

69 The light used for F/A is absorbed by the RPE, and thus can not take imaging of the Choroidal circulation.

70 ICG Angiography

71 Indocyanine green (ICG) is a tricarbocyanine dye that absorbs Infra-Red (non-visible) light. ICG is almost 98% plasma protein bound. This high degree of protein binding results in the tendency for ICG to remain intravascular.

72 ICG Angiography The Infra-Red wavelenths have the ability to penetrate the retinal layers, enables imaging of the choroidal circulation below the RPE. Thus the image usually take through pigmentation, fluid, or blood in the back of the eye.

73 ICG enhanced imaging of the choroid for, Ischemic diseases, Tumors, Idiopathic syndromes, and Inflammatory diseases.

74 Choroidal Malignant Melanoma

75 Choroidal Hemangiomas

76 Birdshot Chorioretinopathy

77 Harada's disease

78 The most practical clinical application of the ICG/A has been in those patients with ARMD. ICG/A unique properties mean that areas of CNV beneath Blood, Exudate, or Pigment Epithelial Detachment (PED) can be imaged more readily.

79 Sub-Retinal Hemorrhage & CNV

80 PED & CNV


82 Hemorrhagic PED & CNV




86 ICG/A complements F/A, which captures blood flow above the RPE. Although ICG/A is not a replacement for F/A, it provides adjunctive information which assists in defining the Choroidal circulatory involvement in Retinal pathology.

87 F/A & ICG/A are valuable adjunct to diagnosis that supports and enhances, but does Not Replace, standard Clinical Examination.


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