FUNDUS FLUORESCEIN ANGIOGRAPHY USES IN OPHTHALMIC PRACTICE
Fundus fluorescein angiography (FFA) is a procedure, which allows us to diagnose and manage various types of retinal disorders.
Indications of FFA
1. Diabetic retinopathy
2. Vaso-occlusive disorders
3. Eales’ disease
4. Central serous retinopathy
5. Cystoid macular edema
Technique
Pupils of both eyes are dilated.
Patient is seated against fundus camera.
3 ml 20% or 5 ml 10% sodium fluorescein dye is injected aseptically in ante-cubital vein and serial photography of fundus is done.
First photograph is taken after 5 seconds, then every second for 20 seconds and then every 2-3 seconds for one minute.
Photography is done for both eyes. Last picture is taken after 30 minutes.
Side Effects
It is a relatively safe procedure.
However patient may develop allergic
reaction to dye like nausea, vomiting, rashes and anaphylactic shock.
A prefilled syringe of dexamethasone and chlorpheniramine maleate (CPM)
should be ready to face such emergencies.
All patients complain of yellowish discoloration of skin and urine.
This dye is nephrotoxic. So this procedure should not be done in
nephro compromised patients as the dye is excreted in urine.
Phases of FFA
1. Pre-arterial phase:
There is no dye in the circulation.
2. Arterial phase:
Dye can be seen in arterioles.
3. Arterio-venous phase:
Some dye can be seen in both arterioles and venules.
4. Venous phase:
There is no dye in arterioles. It can be seen in venules.
Abnormalities Detected by FFA
FFA detects two types of abnormalities namely:
1. Hypofluorescence:
Various causes are occlusion of blood vessels, hemorrhage or exudates.
2. Hyperfluorescence:
Various causes are damage to RPE, pooling of dye as occurs in CME, CSR and micro aneurysms.
FFA gives a very peculiar pattern in
some diseases like inkblot appearance and smoke stack appearance in CSR and flower petal appearance in CME.
Thus, FFA is very important tool for diagnosis and management of fundus disorders.
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OPHTHALMIC PROCEDURES