Effects of aging on fluorescein leakage in the iris and angle in normal subjects.

PURPOSE: To determine the presence of fluorescein leakage from the iris and angle in normal subjects, and how it is affected by aging. METHODS: The subjects were 92 normal volunteers and patients with senile cataract who ranged in age from 20 to 93 years and were free from any systemic or ocular diseases. Fluorescein iris and angle photography and color iris and angle photography were performed using a goniolens and a photo slit lamp. RESULTS: Radial ciliary body vessels were found in 22 eyes (24%), radial iris vessels or trabecular vessels in 7 eyes (8%), and circular ciliary band vessels were seen in 4 eyes (4%). Goniovessels were found in 8 of 30 eyes (27%) of those under 50 years of age. No significant difference in the incidence of goniovessels was found between those over and under age 50 (P < .01). In the pupillary margin, fluorescein leakage was seen in 1 of 30 eyes (3%) in the age group under 50 years, whereas leakage was found in 30 of 62 eyes (48%) in the age group over 50 years. In the anterior chamber angle, leakage was seen in 4 of 30 eyes (13%) under age 50 years, and in 38 of 62 eyes (61%) over age 50 years (P < .05). CONCLUSIONS: These findings suggested that the incidence of leakage of fluorescein from the pupillary margin and anterior chamber angle tends to increase with age. Thus, when leakage of fluorescein in angle and iris is observed, it is important to consider the physiological changes resulting from aging.     

Effect of lens implants on iris fluorescein angiography and the iris pigment layer

Fourteen eyes underwent cataract operation and implantation of an iris fixated (Medallion) pseudophakos. Eleven had an uncomplicated per- and post-operative course (group 1), 3 had a subluxation of the lens implant (group 2). The control group (group 3) consisted of the 14 contralateral eyes from group 1 and 2. Two cadaver eyes had a similar lens implanted (group 4). Groups 1-3 were investigated by bilateral simultaneous iris fluorescein angiography and retroiridal stereo transillumination photography. In group 1, one case with pupillary and diffuse semiperipheral leakage areas was observed, in a clinically healthy eye 15 months after the operation. An other one had some leakage at the pupillary border, but not in the area of contact with the loops. Rubbing between iris surface and some parts of the lens did not provoke local leakage. No new vessel formation was found. Pigment layer defects were observed in every operated eye, but no leakage was related to them except in the two pupillary areas mentioned. Mayor pigment defects did not progress in a quiet eye. The iris seems to be to some degree resistant to contact with the parts of the intraocular lens implant.     

Outward transport of fluorescein from the vitreous in normal human subjects

Vitreous fluorophotometry was performed on eight normal subjects to compare the outward and inward permeabilities of fluorescein into the vitreous. The results indicate that diffusion alone does not account for the outward flow of fluorescein in the vitreous. The possible underlying factors and significance of these findings are discussed.Supported in part by PHS grant EYO3106 (Dr. Blair) from the National Institutes of Health (USA); published by permission of the Archives of Ophthalmology     

Light levels in fundus photography and fluorescein angiography

Methods are presented for determining retinal exposures produced by fundus camera systems during photographic and angiographic procedures and for comparing these results with standards developed for the safe use of lasers (ANSI, Z136.1, 1976). Exposures produced by four commonly used camera systems are measured and shown to be between 0.1 and 1.0 times the Z136.1 maximum permissible exposure levels. The absence of standards appropriate for the chronic exposures to broad-band light sources used in diagnostic studies is noted, and the need for designing cameras by maximizing film exposure while minimizing retinal exposure is emphasized.     

荧光血管造影用于国人棕色虹膜新生血管诊断的初步观察

目的观察国人虹膜新生血管（NVI）患者的虹膜荧光血管造影（IFA）表现,与裂隙灯检查对比,探讨IFA在NVI诊断上的临床应用价值。方法对国人40例（40眼）正常者和27例（28眼）各种病因继发NVI患者及24例（27眼）可疑NVI患者,进行了裂隙灯、虹膜彩照和IFA检查。结果正常对照组IFA不显影,呈色素遮蔽荧光,部分（22.2%）大于60岁正常老年人瞳孔缘可见轻微荧光素渗漏。所有NVI患者（100%）IFA显示瞳孔缘和虹膜表面出现小团状、细线状或不规则交叉网状强荧光,充盈迅速,伴有不同程度的荧光素渗漏。对于部分（11.1%）严重眼底缺血患者,IFA可提前于裂隙灯发现NVI。结论IFA在国人棕色虹膜病变特别是NVI的诊断中有应用价值,能够更敏感地显示NVI的形态和位置,并判断其活动性,为NVI的诊断及疗效判断提供了客观依据。     

Biomicroscopy and fluorescein angiography of pigmented iris tumors

The classification of pigmented iris tumors is a difficult clinical problem. Based on the retrospective observation of colour photographs and iris angiograms of 44 pigmented iris tumors observed over 19 years, the authors present an original grading scheme with scores depending on both the biomicroscopical and the fluoroiridographic patterns of the tumors. The biomicroscopical parameters considered were: thickening of the iris in the area of tumor, pupillary distortion and/or ectropion uveae and uneven pigment density. The fluoroiridographic parameters were: early visibility of the anomalous tumoral network, hyperfluorescence inside or around the tumor, and dye leakage at sites remote from the mass. Based on the score of each tumor, the 44 cases were divided into 3 groups with the different degrees of malignancy confirmed by either histological examination or by follow-up behaviour. The authors suggest that routine use of biomicroscopic-fluoroiridographic classification of pigmented iris tumors would be useful.     

Pointing response in normal subjects]

Eye-hand open-loop pointing responses were examined in five normal subjects, with visual cues for relative target localization. Pointing errors differed significantly with the position of the target. In some cases, pointing responses in the dark were significantly different from those in the light. Pointing shifts were also significant between the responses immediately after putting the experimental device on and those 15 minutes after. From these results, it was speculated that visual localization and eye-hand coordination may be influenced by the visual context and the passage of time.     

Rebound nystagmus in normal subjects]

Rebound nystagmus represents a disorder of ocular movement in patients with cerebellar lesions. It was reported, however, that it occurred in normal subjects in darkness. Jerk nystagmus, amplitude of 0.5-2 deg and frequency of less than 2Hz, was evoked after prolonged eccentric fixation and fatigue within about 5 to 15 seconds in 7 normal subjects of the experiment. The nystagmus increased depending on the eccentricity and duration of gaze holding. It also depended on the orbital position 10deg left, 0 deg, 10 deg right after eccentric gaze. It is suggested that rebound nystagmus resulted from the leaky neural integrator of the brainstem, and a shift of the null position in the direction of the eccentric gaze. These two components may cause different types of nystagmus by various combinations.     

The blood-retinal barrier permeability to fluorescein in normal subjects and in juvenile diabetics without retinopathy

The blood-retinal barrier permeability to fluorescein was determined in 20 eyes from 17 normal volunteers (mean age 31 years) and in 20 eyes from 19 juvenile diabetics without apparent retinopathy (mean age 35 years - mean duration of diabetes 6 years). The permeability was in normal subjects (1.1 +/- 0.4) X 10(-7) cm/sec (mean +/- 2 X SD) and in juvenile diabetics (1.1 +/- 0.7) X 10(-7) cm/sec (mean +/- 2 X SD). Thus a break-down of the blood-retinal barrier cannot be demonstrated as a very early and general phenomenon in the early course of the diabetic disease. The fluorescein diffusion coefficient in the vitreous body was determined and juvenile diabetics without apparent retinopathy showed a diffusion coefficient of (0.80 +/- 0.25) X 10(-5) cm2/sec (mean +/- 2 X SD), which was the same as in normals where the diffusion coefficient was (0.69 +/- 0.46) X 10(-5) cm2/sec (mean +/- 2 X SD).     

虹膜荧光素血管造影对具有棕色虹膜的中国人前葡萄膜炎的诊断价值

背景 前葡萄膜炎的炎症性损伤与血-房水屏障的破坏有关,裂隙灯下对其病情的检查有一定的限制,而荧光素血管造影能客观显示病情的变化.但目前国内对虹膜荧光素血管造影(IFA)的应用研究较少.目的 观察中国人棕色虹膜葡萄膜炎患者IFA图像,探讨IFA在葡萄膜炎诊断和治疗中的临床应用价值.方法 对正常中国人40人40眼和前葡萄膜炎、全葡萄膜炎累及眼前段的患者13例21眼进行裂隙灯、虹膜彩色照相和IFA检查,探讨前葡萄膜炎患眼IFA表现并与正常人进行对照.结果 正常对照眼IFA不显影,呈色素遮蔽荧光,＞60岁正常老年人4例4眼瞳孔缘可见轻微荧光素渗漏.本组葡萄膜炎患眼IFA均有异常荧光素渗漏,按照前葡萄膜炎的严重程度表现为:(1)瞳孔缘和基质层放射状虹膜血管荧光素渗漏.(2)虹膜弥漫性或局限性萎缩,表现为放射状血管透见荧光.(3)虹膜新生血管(NVI),表现为细线状或花团状强荧光,随造影时间延长,有不同程度的荧光素渗漏.结论 IFA可显示裂隙灯检查不能够显示的虹膜炎症性损害病灶并间接反映血-房水屏障和虹膜血管的损害,IFA表现取决于炎症类型、部位以及炎症活动性的严重程度,有助于判断前葡萄膜炎的病情和监测治疗过程.     

眼底彩色照像与荧光素眼底血管造影对判断糖尿病视网膜病变临床分期的一致性研究

目的 探讨眼底彩色照像与荧光素眼底血管造影(FFA)对判断糖尿病视网膜病变(DR)临床分期的一致性.方法 为系列病例研究.选择行FFA检测的99例(188只眼)糖尿病患者,均经眼底镜检查除外轻度非增生性糖尿病视网膜病变(NPDR)和严重增生性视网膜病变(PDR).所有患者在行FFA检测之前,拍摄眼底彩色照片,每只眼获得5张非立体、50°角视野的眼底彩色照片.根据DR国际临床分类法,对从眼底彩色照片和FFA图像获得的DR临床分期结果进行一致性比较.结果 眼底彩色照像诊断中度NPDR 59只眼(31.4%),重度NPDR 76只眼(40.4%);PDR53只眼(28.2%);FFA检测诊断中度NPDR 50只眼(26.6%),重度NPDR 72只眼(38.3%);PDR66只眼(35.1%).眼底彩色照像与FFA检测在判断DR临床分期方面具有相对的一致性(κ=0.601),在判断是否需要进行全视网膜光凝即达到重度NPDR和PDR方面,两者的一致性相对较高(κ=0.652).结论 眼底彩色照像(5张50°角视野)可以为DR患者全视网膜光凝治疗提供有力依据,FFA检测能够更早、更准确地判断DR病程.     

The normal fundus fluorescein angiogram. IV. A classification of the normal fundus fluorescein angiogram based on angiographic findings in clinically healthy subjects and in diabetics without ophthalmoscopically abnormalities

A comparison of fundus elements in the posterior pole of the eye in a group of 48 clinically healthy subjects and in a group of 17 insulin dependent diabetics showed a significant overrepresentation (P less than 0.05) of hyperfluorescent and hypofluorescent elements among the diabetics, as estimated from serial fundus fluorescein angiograms at 3 examinations during one year. In the diabetics a significant intraindividual variation of hyperfluorescent elements (6/17 eyes) occurred during one year in contrast to the clinically healthy subjects (0/48)-(P less than 0.01). The normal fundus fluorescein angiogram (i.e. in clinically healthy subjects) is characterized by: a wide physiologic variation of the number of hyperfluorescent elements i.e. 0-4 elements or 0-11 elements as assessed with and without a one tailed 10% percentile as an upper limit. Hypofluorescent elements in variable number may occur in 21% (upper limit 10% percentile) or 31% (without an upper limit) of normal eyes. No intra-individual variation of these hyper- and hypofluorescent elements developed during the observation period.     

Iris fluorescein angiography and iris indocyanine green videoangiography in pseudoexfoliation syndrome

BACKGROUND: Precise evaluation of the iris vascular pattern in pseudoexfoliation syndrome (PXS) may be difficult with iris fluorescein angiography (IFA) because of the frequent presence of a heavily pigmented iris and conspicuous late leakage. However, iris indocyanine green videoangiography (IICGV) can precisely visualize details of the iris vascular pattern. This study analyzed the utility of IICGV in detecting microvascular changes in PXS and compared these findings with those of IFA. METHODS: Twenty-eight patients with PXS in both eyes underwent an ophthalmic examination including IFA and IICGV. IICGV was done with the IMAGEnet system H1024. RESULTS: IICGV gave better visualization of iris hypoperfusion and anastomotic vessels whereas iris microneovascularisation was far more clearly visible on IFA. IICGV also detected iris pigment epithelium defects. CONCLUSIONS: IICGV can be considered a useful tool for evaluation of the iris vascular pattern in PXS. Iris hypoperfusion did not appear to contribute to the development of iris microvascular changes.     

Iris fluorescein angiography and fluorescein gonioscopic photography after implantation of Choyce Mk IX anterior chamber lenses

Patients underwent intracapsular cataract extraction and implantation of a Choyce Mk IX anterior chamber intraocular lens. At fluorescein angiography (FAG) at a mean of 8 months post-operatively, 9 showed leaking from the iridal vessels, and 3 were normal: Three cases were excluded because of factors affecting the iris FAG. At a mean of 37 months 5 still had a slight degree of leakage. No primarily negative iris FAG changed to positive later. Fluorescein gonioscopic photography (FGP) revealed leakage in 29.5% of the tips of the foot plates at a mean of 37 months. No correlation was observable between FGP and gonioscopy. The pupillary deformation quotient DQ (greatest: smallest pupillary diameter) was significantly greater at a mean of 8 months in the eyes with leakage in iris FAG than in eyes without leakage (P = 0.0145). Individually a change both in direction against normalisation and in elongation was recorded during the observation time.     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.