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                                 EVOLUTION OF FA
           • Bedell (1935)
            “Eventually,drawings will be supplanted
             and even the most skillful artist will be
             forced to admit the superiority of
             photographs ”
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                                 EVOLUTION OF FA
           • Novotny H.R.and Alvis D.L.(1961)

                 “A method of photographing
                 fluorescence in circulating blood in
                 human retina”in the journal ‘Circulation’
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                   RETINAL VASCULATURE
           • Dual blood supply
           • End arterial supply
           • Devoid of anastomosis and AV shunts
           • Cilio-retinal artery-20-30%
           • Major retinal art and ven lie beneath ILM
           • Retinal art rami do not penetrate deeper than
             INL
           • Retinal capillary density-maximum at macula
             and absent at fovea and periphery
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                   RETINAL VASCULATURE
           • Capillary arrangement - Renal glomerule like
           • Capillary - Non fenestrated endothelium
           • Avascular zone in fovea
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                       CHOROIDAL VASCULATURE

               •     Predominant arterial supply to macula
               •     Lobular Pattern - Arteriocentric orVenocentric
               •     Choriocapillaris-No pigment-Minimal laser absorption
               •     Endothelial:Pericyte ratio-6:1(High Permeability)
               •     Outer layers-Ch.Vs.impermeable
               •     Venous Drainage-Segmental
               •     Watersheds-Vertical and Horizontal
               •     Short PCA-End arteries
               •     Blood flow/min highest
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           • FLOURESCENCE ?
           • PHOSPHORESCENCE ?
           • STOKE”S LAW ?
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           • SCAN-0007
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           • INNER BRB
           • OUTER BRB
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                                              SPECIAL FFA
           • Oral FFA—1gm dye in citrus drink
           • Photographs at 30,45,60min
           • Used in Cystoid macular edema and
             papilloedema
           • ANT SEG FA
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                                                      FA - ICGA
           • Sodium fluorescein                                                 • Indocyanine Green
             Visible spectrum                                                     Infrared Spectrum
             Silver halide film                                                   Infrared Spectrum
             Study Retinal                                                        Study Choroidal
             Vasculat Blue                                                        Vasc Infrared Filter
             Green Filter                                                         High Expense
             Lower expense
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                      FLUORESCEIN SODIUM
           •     Xanthine derivative
           •     M.W.-376.27
           •     70-80%Protein bound
           •     Range of absorption and Emission
                 WL-465 and530nmM
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                       FLUO.Na - INDOCY.Grn
           • 376
                                                                                    •      775Daltons
           • 485nm
                                                                                    •      810nm
           • 530nm                                                                  •      835nm
           • 80%                                                                    •      98%
           • Fluo.Angio                                                             •      Choroidal angio
           • Excellent fluorescence                                                 •      1/25th of Na Fl
           • 6mg in 3ml                                                             •      40mg in 2ml
           • Good Solubility
                                                                                    •      Poor Solubility
           • Stable for days
                                                                                    •      Unstable used in 10 hrs
           • Sideeffects-more
                                                                                    •      Less common
             common
                                                                                    •      Dark green
           • Color-Darkroom/red
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                            SIDE EFFECTS-ADVERSE
                                  REACTIONS
           • Staining of                                                        • Nausea,vomiting,va
             skin,sclera,mucous                                                   sovagal
             memb,secretions                                                      response,urticaria,fa
           • Erythropsia                                                          inting,periphlebitis
           • OrangeYellowColor                                                  • Bronchospasm
             ation of Urine                                                     • MI,circulatory shock
           • Flushing,tingling,sne                                              • Convulsions
             ezing,pruritus                                                     • Skin necrosis
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                                         TERMINOLOGY
           •     Fluorescence
           •     Filter
           •     Hyperfluorescence
           •     Hypofluorescene
           •     Autofluorescence
           •     Control photograph
           •     Pseudofluorescence-early/late
           •     Identification tag
           •     Arm-retina circulation time-10 -12sec
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                                          TERMINOLOGY
      • Arterial phase-1-2sec
                                                                                           • Leakage
      • Early venous phase
                                                                                           • Window Defect
      • Peak phase
                                                                                           • Staining
      • LateVenous phase
                                                                                           • Blocked Fluorescence
      • Recirculation phase                                                                • Capillary non perfusion
      • Late phase angiograms-3-5min                                                       • Artefacts
      • Pooling
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                     THE NORMAL FLUORESCEIN
                           ANGIOGRAM

           • Baseline photos
             (autofluorescence/pseudofluorescence) are taken
           • 0 sec                         :               Inject fluorescein
           • 9.5 sec.                      :               Posterior ciliary arteries fill
           • 10 sec.                       :               "Choroidal flush"- background
                                                            choroidal fluorescence
           • 10 -12 sec :                                   Retinal arterial stage
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     • 13 sec                       .               :               Capillary transition stage
     • 14-15 sec                                    :               "Early venous stage", lamellar
                                                                      flow stage",
                                                                    "arterial-venous stage"
     • 16 -17 sec.                                  :                Venous stage
     • 18 -20 sec.                                  :                Late venous stage
     •      5 min.                                  :                Retrofluorescence, late staining
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           • SCAN-0018




     RED FREE PHOTO GRAPH
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      ARTERIAL PHASE
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                                                                       EARLY VENOUS PHASE
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       LATE VENOUS PHASE
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RECIRCULATION PHASE
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               SAMPLE FRAGMENT OF DECISION TREE
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                    HYPERFLUORESCENCE
           •     PREINJECTION
           •     INCREASED TRANSMISSION
           •     LEAKAGE
           •     POOLING
           •     STAINING
           •     ABNORMAL VESSELS


           •
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           • The Abnormal Fluorescein Angiogram:
              – Analyzed...
              – Sequentially
              – Anatomically
              – Morphologically
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             HYPERFLUORESCENCE - LEAKAGE
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               HYPERFLUORESCENCE - POOLING
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       HYPERFLUORESCENCE - WINDOW DEF
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               HYPERFLUORESCENCE - STAINING
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                       HYPOFLUORESCENCE
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                       HYPOFLUORESCENCE
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            HYPOFLUORESCENCE-VFD
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              CYSTOID MACULAR OEDEMA
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                                                                 CSR
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                                                                  CSR
           • SCAN0021
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                                                                  BRVO
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                                                          BRVO
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                                                                 CRVO
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                                                                CRAO
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                                                                  BRAO




                                                                                           Cont….
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                                                                BRAO
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                           PSEUDO PAPILLOEDEMA
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                                  TRUE PAPILLOEDEMA
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      ARMD
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                                                               CNVM
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                   C.N.V.M CLASSIFICATON
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         SRNVM
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                                                            EALE’S




                                                                                           Cont..
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                                                            EALE’S
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                                                            EALE’S
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                                                               EALE’S
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                                                         COATS
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                          DR – MACULOPATHY
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                             DIABETIC RETINOPATHY
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                                                                     NVD
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                   CHOROIDAL MELANOMA
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                      MACULAR INFARCTION
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                      MACULAR INFARCTION
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                                                             ?..
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