Exam (elaborations)
fluorescein angiography
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fluorescein angiography
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FLUORESCEIN ANGIOGRAPHYQUESTIONS WITH VERIFIED ANSWERS
j filters used - exciter filter - lets in blue light
barrier filter - lets out green light
which vessels normally leak FL - choriocapillaris
causes staining of choroidal tissue, Bruch's, sclera
what type of fluorescence does the lamina cribrosa exhibit and why? - hyperfluorescence
bc of staining of visible sclera from adjacent choriocapillaris
which vessels fill first? - chorioidal - derived from ciliary arteries - have a shorter course from the
ophthalmic artery than the CRA to retinal vessels
where is RPE pigment densest? - in the foveomacular region
-more pigment per RPE cell
-cells are tall/columnar with several layers of melanosomes crowded together
what type of fluorescence is seen in the fovea? why? - hypofluorescence (in the foveal avascular zone)
-higher concentration of pigment
-xanthophyll is present in fovea (probably in OPL)
-absence of retinal vessels in fovea (FAZ = 400-500um in diameter in the centre of the fovea)
normal phases of the angiogram - choroidal flush
arterial
arteriovenous
venous
recirculation and late
choroidal flush phase - 10-12 sec after injection in young pts
12-15 sec after injection in old pts
patchy filling is normal, but disappears w/in 5 sec
(GCA would delay this)
arterial phase - begins 1-3 sec after onset of choroidal flush
, only takes 1 sec for arteries to fill (empty in one frame, filled in the next frame)
should you be able to see a leading edge during the arterial phase? - no - this would indicate inflow
disturbance and is highly abnormal
arteriovenous phase - arteries are completely filled
venous jlaminar jfilling joccurs j(see jdye jat jthe jperiphery jof jthe jvessels)
venous jphase j- jcomplete jvenous jfilling j- jpresent jat j11 jsec jafter jinitial jappearance jof jdye jin jthe
jcorresponding jartery
recirculation jand jlate jphase j- j~40 jsec jafter jinjection j-- jthe jfirst jhigh-conc jflush jof jFL jbegins jto jempty
jfrom jthe jchoroidal jand jretinal jcirculations j
recirculation j- jFL jin ja jlower jconc jcontinues jto jpass jthrough jfundus jcirculation
3-5min jafter jinjection, jchoroidal jand jretinal jvasculatures jslowly jbegin jto jempty jand jbecome jgrey
how jlong jdoes jit jtake jnormal jvessels jto jcomplete jempty jof jFL? j- j~10-15 jmin
abnormal jhyperfluorescence jcan jbe jdue jto j- jabnormal jpresence
greater jconcentration
transmission jdefect
hyperfluorescence jdue jto jabnormal jpresence j- jfluorescence jthat jremains jafter jthe jvessels jhave
jemptied j- jis jextravascular jfluorescence j
due jto:
-leakage j- jsize jof jfluorescent jarea jwill jincrease jin jsize jand jintensity jas jstudy jprogresses
-pooling j- jleakage jinto ja jdistinct janatomic jspace
-staining j- jleakage jdiffused jinto jtissue
hyperfluorescence jdue jto jgreater jconcentration j- jdye jis jwhere jit jis jsupposed jto jbe, jbut jin ja jgreater
jconcentration jthan jnormal
ex. jvascularized jtumour jin ja jnormally jvascular jchoroid
malignant jmelanoma jwould jhave jthe jsame jpresentation
hyperfluorescence jdue jto ja jtransmission jdefect j- jnormal jfilling jof jchoriocapillaris, jbut jis jmore
jnoticeable jdue jto jdecreased jpigment jin jRPE jor jloss jof jRPE j--> jpigment jepithelial jwindow jdefect
-major jcause jis jRPE jatrophy j
4 jmajor jcharacteristics:
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