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Fluorescein
- Binds 80% to albumin and other serum proteins
- 90% excreted by kidneys (remainder via liver) within 24 – 36 hours
Phases
- Fluorescein enters the choroidal circulation through short posterior ciliary arteries, approximately 10 -15 seconds after injection (Arm-Retina time should be <20 seconds); choroidal capillary filling phase usually completes during arteriovenous or early venous phase
- Central artery filling occurs about 1-2 seconds after choroidal filling
- Arteriovenous (AV) phase occurs 1-2 seconds after arterial phase
- Venous filling takes about 10 – 12 seconds
Side Effects
- Skin and conjunctival discoloration for up to 8 – 12 hours post injection
- Nausea (3 – 15%)
- Vomiting (5%)
- Pruritus (5%)
- Anaphylactic reaction 1 in 100,000
- Death 1 in 220,000
Findings
- Hyperfluorescence:
- Leakage: in fenestrated choriocapillaris, iris vessels
- Staining: in structures like collagen
- Pooling: in fluid accumulations
- Window defects: in RPE defects
- Hypofluorescence:
- Blocking phenomenon: due to opacities reducing fluorescence, e.g., RPE, blood, xanthophyll
- Filling defect: in ischemia
- CAUTION: Fluorescein passes the Bruch’s membrane but not the RPE or retinal capillaries
- Autofluorescence
- Visible before fluorescein administration, e.g., in optic disc drusen, in astrocytic hamartomas, in large lipofuscin deposits
Sources
- EyeWiki Fluorescein Angiography
- Zahran Y. How to read fluorescein angiography. Adv Ophthalmol Vis Syst. 2015;2(4):131-136. DOI: 10.15406/aovs.2015.02.00054
- Eyeguru.org – How to interpret fluorescein angiography
- Kanski’s Clinical Ophthalmology: A Systematic Approach; John E Salmon MD; Elsevier; 9th Edition (2019)
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition (2021)