ocular angiography

Ocular Angiography

Shima’a Jaffer Al-Amer

211504748

Fluorescein angiography

Refer to photographing fluorescein dye in the retinal vasculature following I.V injection of fluorescein solution

Fundus Camera

Indications

Diabetic retinopathy

Age related macular degeneration

Central\ Branch retinal vein occlusion

Central serous chorioretinopathy

Central \ Branch retinal artery occlusion

Clinical researches

Phases of an

Angiogram

10 seconds following injection.The major choroidal vessels are impermeable to fluorescein, but

the choriocapillaris leaks fluorescein dye freely into the extravascular space.

Early Phase: 1. Choroidal flush.

12 secondsA delay circulatory problems

2. Arterial phase.

Complete filling of the retinal capillary bed follows the arterial phase and the retinal veins begin to fill

3. Arteriovenous phase.

30 seconds after injection.The perifoveal capillary network is best visualized

4. Venous phase.

recirculation phase2 to 4 minutes

The veins and arteries remain roughly equal in brightness.

Mid Phase

gradual elimination of dye 7 to 15 minutes

Late staining of the optic disc is a normal finding.late hyperfluorescence Abnormality

Late Phase

The Abnormal

Angiogram

Abnormal angiographic findings

Hypofluorescence

Filling defect

Blocking defect

Hyperfluorescence

Autofluorescence

Psuedofluorescence

Transmission or "window” defect

Leakage

Pooling

Staining

Hypofluorescence

Hypofluorescence is the reduction or absence of normal fluorescence.

Hypofluorescence is caused by either blockage of the normal fluorescence pattern or abnormalities in choroidal or retinal vascular perfusion.

Blocking

caused by blood or deposition of abnormal materials such as lipid exudate, lipofuscin, xanthophyll pigment or melanin pigment.

preretinal hemorrhage from proliferative DIABETIC retinopathy retinal and choroidal vasculature

subretinal blood from exudative age-related macular degeneration only the choroidal circulation

Filling defect(Hypoperfusion)

Retinal: retinal arterial and venous occlusions and ischemic disease

Choroidal: ophthalmic artery occlusion, giant cell arteritis, and hypertensive choroidopathy.

Hyperfluorescence

Hyperfluorescence is an increase in fluorescence resulting from the increased transmission of normal fluorescence or an abnormal presence of fluorescein at a given time in the angiogram.

Autofluorescence

occur naturally in certain pathologic conditions

such as optic nerve drusen and astrocytic hamartomas.

Transmission defect

Depending on the density of retinal pigmentation

background fluorescence from the choroid can be visible as hyperfluorescence

damage of the retinal pigment epithelium

Leakage defect(extravasation)

disruption of the retinal vascular endothelial cell tight junctions or the breakdown of the tight junctions between retinal pigment epithelial cells

proliferative diabetic retinopathy, optic disc or retinal neovascularization

Staining

fluorescein dye into certain tissues.

Drusen and chorioretinal scars

Normal staining can occur in the optic nerve and sclera as a result of normal choroidal leakage

Pooling

accumulation of dye within a distinct anatomic space.

serous detachments of the sensory retina or the retinal pigment epithelium

Central serous chorioretinopathy

Indocyanine Green Angiography

ICG is used to acquire an angiogram of the choroid.

ICG angiography uses Indocyanine Green dye, which fluoresces in the infra-red (non-visible) light.

The infra-red wavelenths have the ability to penetrate the retinal layers making the circulation in deeper layers visible when photographed with an infra-red sensitive camera.

Case Example

In the case of a patient with 20/100 vision, the fluorescein angiogram demonstrated leakage of fluorescein dye over a large area near the fovea.

Traditional treatment would dictate that the entire area of leakage be treated with laser surgery.

The treatment of this lesion would cause an instant decline in vision to 20/400.

Cont.

The ICG angiography, performed on the same day, reveals a pinpoint leak not visible with fluorescein angiography.

Focal treatment based on the ICG angiogram caused an increase in vision from 20/100 to 20/80

Late Phase FA Late Phase ICG

Any Questions?

Refrences

OPHTHALMIC PHOTOGRAPHERS’ SOCIETY

Ophthalmology and Visual Sciences, UNIVERSITY IOWA CARVER COLLEGE OF MEDICINE

Diagnostic Procedures in OPHTHALMOLOGY by HV Nema & Nitin Nema