Fluorescein angiography of the fundus: A schematic approach to interpretation

Fluorescein angiographic patterns reveal a wide variety of anatomical, pathological and physiological information which, correctly interpreted, contributes to the differential diagnosis of fundus diseases and to the evaluation of appropriate therapeutic approaches. A schema for interpretation of the fluorescein angiogram is presented, following a logical progression from the initial determination of abnormal hypofluorescence or hyperfluorescence to the evaluation of the specific locations and features of the patterns, and their relationships to various disorders.     

Use of digitized fluorescein angiogram system to guide laser treatment of diabetic macular edema: a new technique

We describe our technique to guide laser treatment in diabetic patients with clinically significant macular edema using a digitized fluorescein angiogram system. A pretreatment red-free photograph overlaid on a fluorescein angiogram is processed with the aid of the digitized fluorescein angiogram system in order to include all the important traces on it. The processed red-free image is used by the surgeon as a guide to the laser photocoagulation, improving treatment accuracy and safety for patients with diabetic macular edema.     

A slitlamp comparator system for macular photocoagulation

A slitlamp comparator device has been developed to project the image of a 35mm angiogram frame into the field of view of a standard slitlamp during macular photocoagulation. The image may be varied in brightness, magnification, and position, and viewed either on a black background or superimposed on a slitlamp fundus image. The comparator is a useful alternative to conventional angiogram projection systems and suggests the utility of more sophisticated "heads-up" display devices.     

Osseous choristoma of the choroid

Two patients developed bone choristoma of the choroid, one case being unilateral and the other bilateral. In both cases the clinical diagnosis was confirmed by B scan ultrasonography and computerized axial tomography. Infrared angiography with indocyanin green was carried out on both eyes of the patient with bilateral lesions. The angiogram showed multiple small vessels within the tumor. However, the angiogram with indocyanin green was quite different from the angiogram observed in cavernous choroidal hemangioma. One patient had an associated cleft palate, this being supportive evidence of the hypothesis of a developmental tumor of the choroid.     

Effect of contact lens biomicroscopy on the clarity of fluorescein angiography

To study the effect of contact lens fundus biomicroscopy on the clarity of subsequent fluorescein angiography, the authors compared the fluorescein angiogram from 20 eyes recently examined using a fundus contact lens with fellow control eyes. Saline solution was used to couple the lens to the cornea. In 15 (75%) of the 20 pairs of eyes studied, there was no difference in the fluorescein angiogram clarity between examined and control eyes. In five (25%) patients, there was a slight asymmetry in clarity between the examined and control eyes, but this did not affect the ability to interpret the angiogram. The results were verified by comparing the overall quality of the transit phase of the angiograms. The application of a fundus contact lens to the cornea using saline solution as a coupling agent does not adversely affect the clarity of subsequent fluorescein angiography.     

Papillopathy in the adult as first manifestation of diabetes

PURPOSE/METHODS: A 72-year-old woman that did not know to suffer diabetes was observed to present a bilateral papillopathy with no visual compromise during the postoperative control of cataract surgery. Follow up was performed by fluorescein and indocyanine green angiogram, ophthalmoscopy and campimetry. RESULTS/CONCLUSION: Papillopathy presentation was asymmetric in both eyes. Systemic work up showed a diabetes. Optic nerve oedema resolved spontaneously without optic disc pallor. Diabetes papillopathy is an uncommon process in the elderly but it must be suspected in cases of optic nerve swelling with paucity of symptoms.     

Clinicopathologic correlation of fluorescein and indocyanine green angiography in exudative age-related macular degeneration

PURPOSE: To correlate the clinical and histopathologic features of an eye with age-related macular degeneration studied with fluorescein (FA) and indocyanine green (ICG) angiography 4.5 months before the patient's death. METHODS: Histopathologic features from serial sections through the macula of a 76-year-old man with occult choroidal neovascularization (CNV) were reconstructed in a scaled two-dimensional map and compared with FA and ICG angiogram images obtained 4.5 months before his death. RESULTS: The region of prior laser photocoagulation was identified as a well-demarcated hypofluorescent region in the early frames of the FA and the early and late phases of the ICG angiogram. This corresponded histopathologically to a well-circumscribed area of absence of the choriocapillaris, loss of the outer retina and retinal pigment epithelium, and scarring of the choroid. Occult CNV characterized by elevated late hyperfluorescence on the FA and intense well-defined hyperfluorescence on the ICG angiogram corresponded to a thick fibrovascular membrane in the subretinal space and within Bruch's membrane. Thin extensions of both the subretinal and intra-Bruch's membrane fibrovascular membrane components corresponded to nonelevated stippled late hyperfluorescence on the FA and mild late hyperfluorescence on the ICG angiogram. CONCLUSION: Histopathologic mapping revealed a large fibrovascular complex located subretinally and within Bruch's membrane with thin and thick components that correlate well with findings of occult CNV on FA and ICG angiography.     

Assessment of angiographic retinal capillary nonperfusion in central retinal vein occlusion

We studied the reproducibility and accuracy of eight retinal specialists in assessing the extent of retinal capillary nonperfusion on fluorescein angiograms of 26 central retinal vein occlusions. Each specialist was asked to classify the retinal capillary perfusion status on every angiogram as nonischemic, minimally ischemic, moderately ischemic, markedly ischemic, or uncertain. Criteria for classification of each angiogram were specified in advance for each reviewer. Each examiner individually reviewed every angiogram on two separate occasions separated by at least one month. Intraexaminer and interexaminer reproducibility were both substantially better than the agreement predicted by chance alone (P less than .05); however, the proportion of agreement with the correct classification was less than 60% for all eight specialists.     

The fluorescein angiogram in choroidermia (author's transl)]

The fluorescein angiogram makes a widespread degeneration of the retinal pigment epithelium in choroidermia visible. In the female carriers it shows a spot-like picture. This method of examination contributes to the interpretation of the pathogeny and differential diagnosis.     

Fluorescein angiography of the optic disc in ocular hypertension and glaucoma (author's transl)]

A fluorescein angiography of the optic disc has been performed on 62 eyes in 41 patients suffering from ocular hypertension or glaucoma. The angiogram was abnormal in 32 eyes. 11 eyes showed an absolute hypofluorescence involving the whole optic disc. 15 eyes showed an absolute hypofluorescence limited to a part of the cup and the rim. 6 eyes showed a late hyperfluorescence of the fundus of the cup. Total hypofluorescence throughout all phases of fluorescein angiogram corresponds to filling defects. Absolute hypofluorescence involving the whole optic disc is associated with visual field loss in all cases. Absolute hypofluorescence involving only an area of the optic disc is associated with a normal visual field in a few cases. It is postulated that the limited filling defects without visual fields defects may be an indication of impending loss of the visual field. Therefore fluorescein angiography could be helpful in clinical assessment of visual prognosis of chronic ocular hypertension and glaucoma. Nevertheless wider experience and followup are necessary to confirm the value of the method.     

Arterial fluorescence angiography of the fundus oculi of the cat: appearances and measurements

The technique of fluorescence angiography by arterial injection in the anaesthetized cat is described. The appearances of the angiogram as it affects the choroid, retina and optic disc, and the influence of the tapetum are recorded, and illustrated. Attempts to measure the circulation time proved disappointing, the 95% confidence limits being ±47% of the mean value, 1·06 sec.The features of the angiogram are discussed with particular reference to multiple-dye entry and injection artefacts, the difficulties of measuring circulation time in the cat, the duration of peripapillary choroidal fluorescence, and the significance of tapetal reflectance. Using rapid small-volume injections, repeated angiograms of high quality with good retinal capillary bed detail could be obtained from the healthy eye despite intense choroidal fluorescence over the tapetum which cleared before capillary detail faded.     

Pigment epithelium defects after submacular surgery for choroidal neovascularization: first results

It was the aim of this study to compare postoperative pigment epithelium defects after submacular surgery for well-defined choroidal neovascularization (CNV) with preoperative fluorescein angiogram (FAG), indocyanine green angiogram (ICG), and intraoperative findings of the excised neovacularization. Surgical removal of the CNV was videotaped. By means of a gauge the absolute size of an anatomic structure was determined which was visible on video, FAG, and ICG as well. Postoperatively another FAG was performed to further examine the funduscopically visible pigment epithelium defect. By comparison with the above-mentioned anatomic structure it was thus possible to determine the exact size of CNV and pigment epithelium defect. The extent of the pigment epithelium defect as determined on postoperative FAG after submacular surgery surpasses the size of CNV as measured in FAG, ICG, and anatomical preparation.     

周细胞在新生血管性眼病中的作用研究进展

新生血管性眼病以病理性新生血管形成为病理特征,是威胁眼健康的主要疾病。近年来,各种新生血管性眼病发病率逐年提高,已成为严重的公共卫生问题,引起了广泛关注。病理性新生血管是多种细胞成分、多种病理因素互相包含、交互影响下形成的,单独干预其中一种因素往往很难达到理想治疗效果,因此需要更深入地研究新生血管的病理过程,探究新的调控新生血管的因子,以发现更有效的治疗方法。近年来研究发现,周细胞在多种新生血管性眼病的发生发展中起重要作用,针对周细胞采取干预措施将影响这些疾病的病理过程。本文将对新生血管性眼病中周细胞的具体作用以及调控周细胞的因素作出综述,为新生血管性眼病的治疗提供新的思路和方向。     

Early changes of the vascular system of the eye in hyperlipoproteinemia

A complete ophthalmological examination including fluorescein angiography of the retina, iris, and limbus corneae was performed in 77 patients suffering from hyperlipoproteinemia. An abnormal angiogram of the retina was observed in one-third of the cases and in 50% of the irises, respectively. The common angiographic findings were hyperpermeabilities of vessels. The results of the study identify hyperlipoproteinemia as a vascular risk factor. Its relationship to atherosclerosis is discussed.     

Retinal neuronal relationships in health and in optic neuropathy of glaucomatous genesis

A new procedure is proposed to study oscillatory potentials (OP), by using long-term flash ERG. OPs for on- and off-ERG were isolated, by employing mathematical filters (80-200 Hz). This procedure was used to examine 25 healthy subjects and 40 patients with different stages of glaucoma. The procedure could ascertain the site of a pathological process in the on- or off-cone cell system, each showing a different sensitivity. The use of this study opens up new avenues for the study of both pathological processes in the on- and off-cone cell systems from distal to proximal portions and pathogenetic mechanisms responsible for development of retinal and optic nerve diseases.     

MicroRNA在年龄相关性黄斑变性发病中的作用

近期研究发现,ｍｉｃｒｏＲＮＡ在许多病理生理学过程中起关键作用。其病理生理学过程包括病理性血管新生、氧化应激反应、免疫反应和炎症反应等,它们在年龄相关性黄斑变性的病理发展过程中有重要的作用。ＭｉｃｒｏＲＮＡ对这些过程有调控作用,并有可能成为治疗黄斑变性的新的靶点。本文将就目前已知的或可能与年龄相关性黄斑变性有关的ｍｉｃｒｏＲＮＡ进行综述。     

A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.     

Visual loss following removal of intraocular silicone oil

AIM: To investigate the cause of visual loss following removal of intraocular silicone oil in patients who underwent vitrectomies for retinal detachment or giant retinal tear. METHODS: The clinical records of three cases with visual loss following removal of silicone oil were reviewed. Investigations carried out included fundus fluorescein angiogram, optical coherence tomography, and electrophysiological studies. RESULTS: Visual acuities dropped from 6/9 to 6/36 in two cases and 6/24 to 3/24 in the third. None of the three cases had macula detachment at any stage. Fundus fluorescein angiogram and optical coherence tomography were normal in all cases. Pattern electroretinogram showed reduced amplitudes of the P50 and N95 components. Multifocal electroretinogram indicated a selective damage to the central part of the macula. CONCLUSIONS: The results suggest that the abnormality arises predominantly in the central part of the macula, especially the outer and middle layers. However, the exact mechanism still remains obscure.     

Retinal angiopathy and polypoidal choroidal vasculopathy

PURPOSE: To describe the clinical and angiographic features of patients with polypoidal choroidal vasculopathy, exudative detachment of the macula, and an associated retinal microangiopathy. METHODS: Case series. RESULTS: Four patients with chronic exudative detachment of the macula with a variable degree of lipid deposition are described. The retina in the detached area, but not beyond, was noted to have a microangiopathy. There was capillary telangiectasia, microaneurysm formation, patchy nonperfusion, and intraretinal leakage. In each patient, there were no other retinal vascular changes in the fundus of either eye. The fluorescein angiogram showed subretinal leakage suspicious for occult choroidal neovascularization. The indocyanine green angiogram showed the presence of underlying polypoidal choroidal neovascularization, accounting for the exudative detachment. After photocoagulation, the retinal angiopathy improved, but not completely. CONCLUSION: Retinal microangiopathy may occur in a chronic macular detachment secondary to polypoidal choroidal neovascularization. The development of these secondary retinal changes is not clearly understood; however, hypoxia from the chronic detachment, a neurotoxic effect from the lipid deposition, or a biochemically induced microvascular abnormality from secretion of vasogenic mediators are possible mechanisms. Indocyanine green angiography is helpful in making a definitive diagnosis. Clinicians should be aware that a retinal microangiopathy may occur in such eyes so that the proper diagnosis can be made and appropriate treatment administered.     

Stabilization of the laser on the target. Scanning photocoagulator: the SLC (scanning laser coagulator)

When lasers are used to cause burns on the retina they necessitate systems of great precision especially in the posterior pole. Different possibilities are now offered. The best one is based on the intensification of the same laser beam used for the observation in the Scanning Laser Ophthalmoscope: S.L.O. when it is at a point selected from the angiogram, converting this machine into a Scanning Laser Coagulator: S.L.C.