Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience

BACKGROUND: The last major survey of adverse reactions to intravenous fluorescein angiography was performed more than 20 years ago. There have been two recent fatalities involving intravenous fluorescein in Australia. It is important to review the current incidence of adverse reactions and latest literature on the pathogenesis, prophylaxis and alternatives to intravenous fluorescein angiography. METHODS: A retrospective review of all adverse reactions to intravenous sodium fluorescein in patients undergoing fluorescein angiography between June 1998 and June 2004 was undertaken. The total number of fluorescein angiograms performed and the number of patients with adverse reactions were identified from the photographic department database and the fluorescein adverse reaction register at the Lions Eye Institute. RESULTS: A total of 11 898 fluorescein angiograms were performed during the study period. There were 132 adverse reactions recorded. The commonest adverse reactions were nausea and vomiting. There were no serious adverse reactions or deaths recorded. There was a statistically significant difference in the incidence of adverse reactions between sodium fluorescein used from two manufacturers. CONCLUSIONS: Fluorescein angiography is a relative safe procedure and comparable to other intravenous radiocontrast media angiography or investigation. The present results are consistent with previous studies. Prophylactic treatment, fluorescein desensitization or oral fluorescein angiography should be considered in high-risk patients. Safe guards should be in place to manage potential serious adverse reactions. Other imaging techniques, like optical coherence tomography, should be considered as an alternative in selected cases.     

眼底荧光血管造影不良反应相关因素探讨

目的探讨眼底荧光血管造影(fundusfluoresceinangiography,FFA)不良反应发生的相关因素。方法对连续进行的2078例FFA中发生的不良反应情况进行统计分析。结果不良反应发生率为5.77%,大部分在注射荧光素钠后2min内发生并在2min内好转,最常见的不良反应为恶心呕吐(79.17%)、荨麻疹(12.50%)及晕厥(4.17%)。在本文涉及的影响因素如年龄、性别、气候、药品批号、有无“诱导”等中,仅年龄1项在统计学上有显著差异(t=4.82,P<0.01),并以20~40岁年龄组最为多发(10.17%)。结论FFA是基本安全的眼科检查手段,年龄是不良反应发生最重要的影响因素,过敏反应和精神紧张、迷走兴奋可能是主要的发病机制。     

眼底荧光血管造影不良反应与药物过敏史的关系

目的:分析行眼底血管荧光造影(fundus fluorecein angiography,FFA)静脉注射荧光素钠不良反应的发生率与既往药物过敏史情况之间的关系。方法:观察160例既往有药物过敏史患者及160例既往无药物过敏史患者静脉注射荧光素钠进行FFA时不良反应的发生率,分析不良反应发生率与既往药物过敏史情况的关系。结果:160例有药物过敏史的患者静脉注射荧光素钠后发生不良发应17例(10.6%),160例无药物过敏史的患者静脉注射荧光素钠后发生不良发应15例(9.4%)。不良反应主要为恶心、呕吐、头晕等不适,无心脏骤停、过敏性休克等危及生命的严重反应。统计学分析两组患者之间静脉注射荧光素钠后不良反应发生率的差异无明显统计学意义(χ2=0.165,P>0.05)。结论:FFA静脉注射荧光素钠不良反应的发生率与既往有无药物过敏史没有明显的相关性,药物过敏史患者不是行FFA检查的禁忌证。     

Anaphylaxis following intravenous fluorescein angiography in a vitreoretinal clinic: report of 4 cases

Objective: To assess the incidence of anaphylaxis following intravenous fluorescein angiography (IVFA) at 1 satellite clinic.Study Design: Observational case series. Participants: Records from 1400 patients were reviewed.Methods: Consecutive vitreoretinal patients who underwent IVFA between 1998 and 2005 at 1 satellite office were included for retrospective analysis.Results: Anaphylaxis developed in 4 of 1400 (0.3%) patients within minutes after they had received intravenous fluorescein. In each case, the reaction was recognized promptly and treated with injectable epinephrine by the physician, and symptoms resolved quickly. The ambulance was called in all 4 cases. In the literature, reports of 21 cases of anaphylaxis and 7 deaths have been published in the past 55 years.Conclusions: Although uncommon, anaphylaxis as a reaction to intravenous fluorescein does occur. As this is potentially life-threatening, prompt diagnosis and treatment are crucial. An emergency care plan should be available.     

Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study

Intravenous fluorescein angiography is a commonly performed and extraordinarily valuable diagnostic procedure. The frequency of adverse reactions after angiography has varied considerably in previous reports. In a prospective study of 2789 angiographic procedures in 2025 patients, the authors found that the percentage of adverse reactions depended strongly on the patient's angiographic history. Overall, adverse reactions followed 4.8% of the angiographic procedures. These reactions included nausea (2.9%), vomiting (1.2%), flushing/itching/hives (0.5%), and other reactions (dyspnea, syncope, excessive sneezing) (0.2%). No cases of anaphylaxis, myocardial infarction, pulmonary edema, or seizures occurred. The percentage of reactions was 1.8% for patients who had had previous angiography without ever having had an adverse reaction. In contrast, the percentage of reactions was 48.6% for patients who had had an adverse reaction to angiography previously.     

Adverse reactions to fluorescein angiography: A comprehensive review of the literature

We reviewed literature on adverse reactions to intravenous fluorescein angiography using PubMed and found 78 articles in English from 1961 to 2017. The reported rates of adverse reactions were overall 0.083–21.69%, separated into mild (1.24–17.65%), moderate (0.2–6%), and severe (0.04–0.59%). There were 1:100,000 to 1:220,000 deaths. Fluorescein concentration, volume injected, speed of injection, temperature, and contaminants were not correlated with the incidence of reactions. Patient characteristics including other comorbid diseases, allergy history, age, race, and gender showed only an increased rate of reaction in patients with a history of reaction to fluorescein. Although a number of studies examine techniques to reduce adverse reactions to intravenous fluorescein angiography, to date, the only proven method is reviewing allergy history, specifically a history of previous reaction to fluorescein.     

Allergic reaction to fluorescein dye: successful one-day desensitization

CASE REPORT: An 86-year-old woman developed IgE-mediated generalized urticaria after a second fluorescein injection. A one-day desensitization protocol was successfully administered that permitted continuation of angiography for deteriorating vision. COMMENTS: We review the literature on adverse events associated with administration of fluorescein and suggest guidelines for testing and desensitization.     

Intravitreal sodium fluorescein enhances visualization of clear vitreous during vitreous surgery for macular hole: a safety and efficacy study

Purpose: To assess the safety and efficacy of sodium fluorescein (NaFl) as an aid for clear vitreous vitrectomy. Methods: In 50 consecutive cases of macular hole surgery, NaFl 0.6% prepared from 20% injectable dye was injected into the vitreous cavity after core vitrectomy so as to stain the clear formed vitreous. Results: NaFl stained the peripheral uncut clear vitreous green and improved the visualization for a safe and complete vitrectomy. No complications associated with the dye injection were noted. Conclusion: NaFl 0.6% can safely be used in the vitreous cavity for easy identification of clear uncut vitreous gel for clear vitreous vitrectomy. This enhances expeditious excision of this tissue.     

Corneal fluorescein staining and ocular symptoms but not Schirmer test are useful as indicators of response to treatment in chronic ocular GVHD

Purpose

To evaluate long-term ocular surface clinical signs and symptoms response to therapy in patients with chronic ocular GVHD.

脉络膜黑色素瘤临床病理分析

本文总结了我院１９８５年至１９９１年经病理证实的４０例脉络膜黑色素瘤。分析其临床、超声波、眼底荧光血管造影的特点及病理改变。并对荧光血管造影的病理机制进行初步探讨。眼底荧光血管造影中于肿瘤内的低荧由肿瘤细胞及其内色素、坏死、血窦等所致。而高荧主要由肿瘤内血管和其上脱落的变性的色素上皮细胞所致。     

Dynamic versus static ultra-widefield fluorescein angiography in eyes with diabetic retinopathy: a pilot prospective cross-sectional study

AIM:To analyze differences in ultra-widefield fluorescein angiography(UWFA)findings between dynamic and static images of eyes with diabetic retinopathy(DR).METHODS:This cross-sectional study included 28 eyes of 28 patients with DR undergoing UWFA.A series of UWFA images acquired from each patient were converted into a time-lapse video and used as a dynamic image.A single,clear,arteriovenous phase image was chosen as a static image.Non-perfusion index(NPI)and its correlation with vascular abnormalities in different zones were compared between dynamic and static UWFA imaging.RESULTS:NPI appeared to increase from the center to the far-periphery in both groups.Dynamic NPI was lower in the total retinal area(0.26 vs 0.29,P=0.009)and farperiphery(0.33 vs 0.36,adjusted P=0.042),which was contrary to the static NPI.Far-peripheral NPI was associated with intraretinal microvascular abnormality in the posterior area in both groups.CONCLUSION:Time-lapse dynamic UWFA imaging is a useful modality to differentially diagnose hypofluorescence in the most peripheral region.This modality could provide a reliable method for NPI measurement.     

Contact versus peribulbar anaesthesia in trabeculectomy: a prospective randomized clinical study

PURPOSE: To compare the pre-, intra- and postoperative pain scores and complication rates in trabeculectomy under contact-topical anaesthesia versus peribulbar injection anaesthesia. METHODS: A total of 100 patients selected to undergo primary trabeculectomy were randomly allocated to receive either contact or peribulbar anaesthesia. Patients were asked to rate their pain levels on a 5-point scale for four periods: during the administration of the anaesthetic agent, during surgery, immediately after surgery and 24 hours postoperatively. At the same time, the surgeon was asked to record his subjective assessment of the stress he himself had suffered during the course of the intervention. Surgical parameters, intra- and early postoperative complications were also evaluated. RESULTS: The difference between groups was statistically significant during anaesthetic administration. Six patients who received contact-topical anaesthesia reported mild discomfort during delivery of the anaesthetic agent, while 43 patients complained of mild to severe pain during the injection of bupivacaine (p < 0.001). Thirty-two patients in the contact anaesthesia group and 26 in the injected anaesthesia group reported no pain during surgery (p = 0.127). Only one patient in each group reported mild pain 30 min postoperatively. We found no differences between pain rates after surgery. Complications included prolonged chemosis and we also noted that conjunctival haemorrhage occurred more frequently in the peribulbar group than in the contact anaesthesia group (p = 0.012). CONCLUSION: Both anaesthetic methods provided high levels of pain control without additional sedation during surgery. The use of contact-topical anaesthesia reduces both pain and the possibility of complications during the administration of anaesthetics.     

Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: a critically evaluated prospective clinical study

Aim:

The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG).

Materials and Methods:

In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 Results:The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P <0.001) and the use of medications dropped from 2.92 to 0.39 (P <0.001) after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy.

Conclusions:

Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.     

Effectiveness of the gold weight trial procedure in predicting the ideal weight for lid loading in facial palsy: a prospective study

PURPOSE: To evaluate the effectiveness of the gold weight trial procedure in predicting postoperative eyelid closure after gold weight implantation surgery for facial palsy. DESIGN: Prospective, interventional case series. METHODS: Patients with facial palsy undergoing gold weight implantation were enrolled prospectively to undergo the standard gold weight trial procedure. The criteria for ideal gold weight were defined before surgery as a minimum 50% reduction in lagophthalmos without induction of more than 2 mm ptosis during the trial procedure. The corrected weight (ideal gold weight + 0.2 g) was implanted in the pretarsal space. The main outcome measure was reduction in lagophthalmos according to predefined criteria at six weeks after surgery. RESULTS: Thirty eyes of 29 patients underwent gold weight implantation. The mean age at surgery was 41.6 years, and the median predicted ideal gold weight was 1.2 g. The mean preoperative lagophthalmos of 7 mm reduced to 2.3 mm at six weeks after surgery. As defined by the success criteria, undercorrection was noted in nine eyes (30%) at six weeks after surgery. A preoperative lagophthalmos of 8 mm or more was noted in seven (77.8%) of nine eyes in the undercorrection group, compared with six (28.6%) of 21 eyes in the success group. Six of the nine failures required implant exchange. CONCLUSIONS: The ideal gold weight as estimated by the trial procedure (with 0.2 g correction factor) led to undercorrection in 30% cases. Undercorrection was common (78%) in patients with preoperative lagophthalmos of more than 8 mm.     

Viscoanaesthesia in cataract surgery: a prospective,randomized clinical trial

Purpose: We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. Methods: In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre‐ and postoperatively. Results: Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003?0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64?57.24; p = 0.003). Conclusions: Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema.     

Benefits of using corneal topography to choose subjective refraction technique in keratoconus (RE-CON): a prospective comparative crossover clinical study

Graefe's Archive for Clinical and Experimental Ophthalmology - In prospective no-masking, comparative, crossover monocenter clinical trial, we aimed to evaluate whether the optimal subjective...     

Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy in high myopia: a prospective clinical study

Background  

To study the effect of prophylactic application of mitomycin-C on haze formation in photorefractive keratectomy (PRK) for high myopia.