F. Kianersi MD 1390 / 4 / 2

1. بسم الله الرحمن الرحيم Fluorescein & ICG Angiography F. Kianersi MD 1390 / 4 / 2

2. Sodium fluorescein (C20H10Na2) is a highly water-soluble complex organic molecule with a molecular weight of 376.27. .

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

9. Arterial Phase 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 • Hypo-Fluorescence • Hyper-Fluorescence

14. Hypo-Fluorescence • Vascular Filling Defect • Blockage

15. Hypo-Fluorescence1.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. Vascular Filling Defect Diabetes (Capillary Bed)

21. Vascular Filling Defect (Capillary Bed) Cotton Wool Spot

22. Hypo-Fluorescence2.Blockage • Pre-Retinal • Intra-Retinal • Sub-Retinal • Different Deposits

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

24. Blockage (Pre-Retinal) Pre-Retinal Hemorrhages

25. Blockage (Pre-Retinal) Melanocytoma

26. Blockage (Intra-Retinal) Hemorrhage ,

27. , Blockage (Intra-Retinal Pigment) RPE Hyperplasia

28. Blockage (Sub-Retinal) Hemorrhage

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

30. Blockage (Sub-Retinal) Inflammation (Toxoplasmosis)

31. Blockage (Sub-Retinal) Fluid (CSR)

32. Blockage (Different Deposits) Best Vitelliform Degeneration

33. Hyper-Fluorescence • Window Defect of RPE • Leakage • Anomalous Vessels

34. Hyper-Fluorescence • Window Defect of RPE

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 • Anomalous Vessels • Choroid • Retina • Optic Nerve Head

42. Anomalous Vessels (Choroid) CNV

43. Anomalous Vessels (Choroid) Choroidal Tumor (Melanoma)

44. Anomalous Vessels (Retina) Coats' Disease

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

46. Anomalous Vessels (Retina) (Parafoveal Telangiectasis)

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

48. Leakage Hyper-Fluorescence • Into Tissue Staining • In a Preformed Space Pooling

49. Leakage Into Tissue(Staining)

50. Leakage Into Tissue(Staining) Drusen