Browse the corpus

Fundus fluorescein angiography (FFA) is an invasive diagnostic procedure. It helps to assess the anatomy, physiology, and pathology of retinal and choroidal circulation. It aids in the diagnosis of various ocular pathologies. It contributes to decision-making when planning the management of ocular pathology. It is also useful as a teaching tool. Although it is a safe procedure, there are adverse effects associated with it. This activity outlines the basic principles, techniques, and interpretation of FFA. It also describes the adverse effects associated with the diagnostic procedure and reviews the role of the interprofessional team in managing the adverse events and improving care for patients undergoing this procedure. Objectives: Identify the underlying anatomy and physiology pertinent to fundus fluorescein angiography. Review the equipment, personnel, preparation, technique, and potential complications of fundus fluorescein angiography. Describe the characteristics of various diseases on fundus fluorescein angiography. Explain the importance of the interprofessional team for monitoring and managing a patient during fundus fluorescein angiography. Access free multiple choice questions on this topic.

Fundus fluorescein angiography (FFA) and its clinical role in ophthalmology were discovered by two medical students, Herald Novotny and David Alvis.[1] Flocks and colleagues had earlier experimented with intravenous injection of fluorescein in cats to study retinal circulation.[2] However, when the same was attempted in humans, insufficient lighting of the fundus camera and the absence of a barrier filter prevented them from getting serial images of the fundus to measure the circulation time. With time, fundus camera technology improved. Novotny and Alvis used the new fundus camera and two different filters, blue and green, to image the fluorescence of the dye. They successfully got the first fluorescein angiogram images, which were reported in their published paper in 1961.[3] FFA allows the assessment of the anatomy, physiology, and pathology of the retinal and choroidal vasculature. Sodium fluorescein is an orange water-soluble dye. It has a low molecular weight of 376.3 Da.[4] It remains primarily bound to proteins (80%) in the blood.[5] The retinal vascular endothelium and the retinal pigment epithelium (RPE) act as barriers and do not allow the diffusion of the dye.[6] However, the choriocapillaris allows it to diffuse freely.[7] It is excreted in the urine over 24 to 36 hours and is responsible for the discoloration of urine.[5] It absorbs light in the range of 465 to 490 nm (blue light) and emits light in the range of 520 to 530 nm (green light).[4] FFA is a diagnostic procedure where a series of photographs of both eyes are taken after injecting sodium fluorescein intravenously. Interpretation and understanding of FFA help in the accurate diagnosis and evaluation of various pathologies. This review also discusses the complications and the role of the interprofessional approach in managing patients undergoing FFA.

Extravasation of the dye under the skin is a severe side effect and should be avoided. It leads to severe pain and may cause necrosis of the skin. Applying an icepack to the area of extravasation helps relieve pain. Nausea is the most frequent side effect (0.06 to 15.29 %).[25] However, it is transient. Vomiting does not occur frequently. In patients with a previous history of nausea and vomiting, treatment with oral promethazine hydrochloride (25 to 50 mg) one hour before the procedure helps prevent the episode. Vasovagal syncope occurs in apprehensive patients. It may occur even at the sight of the needle. It may cause the patient to lose consciousness for a few minutes, but it is reversible. A more severe reaction in the form of bradycardia and hypotension may occur. In this case, the patient is made to lie down with their feet elevated. Blood pressure is monitored. The most frequent allergic reactions are mild. This includes hives or itching. Antihistamines are useful in these cases. Severe allergic reactions like bronchospasm, laryngeal edema, and acute myocardial infarction are life-threatening and need urgent care. A few cases of death have been documented with intravenous administration of fluorescein. The emergency equipment and drugs cart should always be available. Epinephrine, steroids, and bronchodilators like aminophylline help treat bronchospasm and severe anaphylactic reaction that may occur. The overall incidence of death has been reported as 1 in 2,22,000.[37]

Interprofessional team care can contribute to using fluorescein angiography most efficiently. Nurses are required to assist in preparing the patient for the procedure. Counseling the patient before the procedure, pushing the dye while the ophthalmologist is capturing the images, and observing the patient for any adverse reactions can all be carried out by the nursing staff. Anesthetists or specialists in critical care are required to manage cases that develop an anaphylactic reaction. An interprofessional team approach helps prevent complications. It helps carry out angiography procedures uneventfully and provides optimal diagnostic information. [Level 5].