Pemeriksaan Fundus Fluorescein Angiography

Pemeriksaan FFA dalam menilai kelainan pada pembuluh darah retina

1. FUNDUS FLUORESCEIN ANGIOGRAPHY OPHTALMOLOGY DEPARTEMENT MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY Dr. MOHAMMAD HOESIN HOSPITAL PALEMBANG 2024 Kiki Rizki Arinda Consultant: Dr. dr. Ramzi Amin, Sp.M , Subsp. VR

2. Fundus Fluorescein Angiography (FFA) Dynamic flow studies of the integrity of retinal vessels , some cases, the study of the vascular integrity of anterior segment To examine the circulation of the retina and choroid using a fluorescent dye and a specialized camera

3. Principle of FFA

4. Retina Blood Flow

5. Retina Blood Flow

6. Fluorescein An orange-red crystalline hydrocarbon Molecular weight 376 dalton 2 -3 mL (25%) / 5 mL (10%) Eliminated : liver and kidney 24-36 hours via urine 80 % protein bound in albumin 20 % unbound Pass through Fenestrated walls of the choriocapillaris Do not pass through Endothelial cell tight junction retinal vessel RPE or zonulae ocludentes Choroidal vessel

7. Normal FFA

8. Normal FFA

9. Phases of FFA 01 02 03 04 05 06 Choroidal Filling Retinal Arterial Filling Venous Lamelar Filling Full Venous Circulation Recirculation Late Phase 8-15 seconds after injection 1-2 sec after choroidal filling 2-3 sec after arterial filling <11 sec after arterial filling 30-150sec after injections 10-30 min after injection

10. Choroidal Filling

11. Retinal arterial filling

12. Arterio-venous filling

13. Full venous filling

14. Re-circulation filling

15. Abnormality of FFA Auto fluorescence Hypo fluorescence Hyper fluorescence

16. Autofluorescence Emission of fluorescein light without fluorescein Optic head nerve drusen Astrocytic hamartoma Filter problem (rare)

17. Hypofluorescence

18. Vascular filling defect

19. Blocked

20. Hyperfluorescence

21. Leakage Marked increase in fluorescence Seep through the RPE into Sub retinal space or retina Out of retinal blood vessel into retina From retina NV into vitreous The borders become increasingly blurred The greatest intensity in the late phase

22. Staining Increase intensity and persist in the late view The margin remain fixed through out the phase Fluorescein entry to the solid tissue Scar Drusen ON Sclera

23. Pooling Accumulation of fluorescein in a fluid-filled space Increase intensity and size but no more than the margin The margin is distinctly seen

24. Window Defect A view of normal choroidal fluorescence through the RPE defect Increase intensity with the peak of choroidal filling Does not increase in size and fade in the late phase

25. CASES

26. Polypoidal Choroidal Vasculopathy

27. Branch Retinal Artery Occlusion

28. Pooling : CSR

29. Staining : Drusen Material

30. Classic CNV

31. Macroaneurysm

32. Branch Retinal Vein Occlusion

33. Proliferative Diabetic Retinopathy

34. SUMMARY Abnormality : Autofluorescein Hypofluorescein Hypefluorescein To examine the circulation of the retina and choroid using a fluorescent dye and a specialized camera Side Effect Nausea Anaphylactic reaction

35. THANK YOU

36. Side effects of fluorescein angiography Nausea, Vomiting, Vasovagal reactions Extravasation with subcutaneous granuloma, toxic neuritis, or local tissue necrosis, very rare Anaphylactoid reaction (urticaria) Anaphylactic reaction (cardiovascular shock)