Overview
Fluorescein Angiography is a diagnostic procedure used to evaluate retinal and choroidal circulation. This examination involves injecting fluorescein dye and photographing its passage through the retinal vessels.
Fluorescein angiography is crucial for diagnosing diabetic retinopathy, age-related macular degeneration, retinal vascular occlusions, and other retinal disorders. It provides detailed information about retinal blood flow and vascular integrity.
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Indications
Evaluation of diabetic eye disease
Assessment of macular degeneration
Evaluation of retinal artery or vein occlusion
Assessment of abnormal blood vessels
Evaluation of choroidal circulation
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes explaining the procedure to patient, obtaining informed consent, dilating pupils, ensuring proper patient positioning, preparing injection equipment, and preparing for potential complications. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure to patient. Obtain informed consent. Dilate pupils. Position patient at camera.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Missing consent
- Poor positioning
💡 Pro Tip:
Explain that yellow skin discoloration is normal and temporary.
Step 2: Equipment Setup
Calibrate fundus camera. Set fluorescein filters. Check injection equipment. Ensure proper function.
⚠️ Common Mistakes to Avoid:
- Poor calibration
- Wrong filters
- Equipment malfunction
💡 Pro Tip:
Always calibrate equipment before procedure.
Step 3: Baseline Photography
Take baseline color and red-free photographs. Document any existing abnormalities.
⚠️ Common Mistakes to Avoid:
- Missing baseline photos
- Poor documentation
- Incomplete imaging
💡 Pro Tip:
Document baseline appearance for comparison.
Step 4: Dye Injection
Inject fluorescein dye rapidly. Start timer. Begin photography immediately.
⚠️ Common Mistakes to Avoid:
- Slow injection
- Poor timing
- Missing early phases
💡 Pro Tip:
Rapid injection ensures good bolus effect.
Step 5: Sequential Photography
Photograph at specific time intervals. Document arterial, venous, and late phases.
⚠️ Common Mistakes to Avoid:
- Missing phases
- Poor timing
- Incomplete documentation
💡 Pro Tip:
Follow standard timing protocol for consistency.
Step 6: Result Analysis
Analyze angiographic findings. Document abnormalities. Compare with previous examinations.
⚠️ Common Mistakes to Avoid:
- Poor analysis
- Missing abnormalities
- Incomplete comparison
💡 Pro Tip:
Always compare with previous angiograms when available.
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Post-procedure Care
Post-procedure care involves monitoring for adverse reactions, documenting findings, comparing with previous examinations, and determining if additional testing is needed. Regular follow-up is essential for patients with retinal vascular disease.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Allergic reaction | 1-2% | Urticaria, pruritus, anaphylaxis | Antihistamines, epinephrine if severe | Check allergy history, emergency equipment |
| Nausea and vomiting | 5-10% | Nausea, vomiting, dizziness | Supportive care, antiemetics | Fasting, proper preparation |
| Extravasation | 1-3% | Pain, swelling at injection site | Local care, monitoring | Proper technique, good venous access |
| Yellow skin discoloration | Common | Yellow skin, urine discoloration | Reassurance, hydration | Proper explanation |
Clinical Pearls
Explain that yellow skin discoloration is normal and temporary.
Always calibrate equipment before procedure.
Document baseline appearance for comparison.
Rapid injection ensures good bolus effect.
Follow standard timing protocol for consistency.
Always compare with previous angiograms when available.
Have emergency equipment ready for allergic reactions.