Authors              Ibrahim Algorafi,MD(Chairman)

                      Walid ALgorafi,MD

                      Yahia al-Dhabbi,MD

Summary         Miscellaneous fundus photography  presented according to the cause, and described in the way of spot diagnosis, critical signs ,all photographs belong to algorafi eye clinic .

Objectives       Upon completion of this online course, the ophthalmologist should be able to

-review Knowledge.

-Differentiate between the diabetic retinopathy and hypertensive retinopathy.

-Differentiate between the CSCR and the Cystoid macular edema.

-suspecting an artifact.

Audience  

Doctors  with 3 years experience in ophthalmology are eligible to enter the test ,Doctors complete the exam test would    offered certificate of completion    .

Introduction :

Fluorescein angiography is frequently an essential part of retinal investigation. However, with an understanding of Fluorescein angiography, it is frequently unnecessary to perform angiography following an examination because of the knowledge of the expected pattern. Thus once the  Fluorescein appearance of the lesion, or lesions, is recognized, then angiography is no longer required. For instance , a cotton-wool spot will always show an area of arteriolar occlusion associated  with capillary closure and knowing this ,  it is not essential to carry out angiography. However in many complex retinal patterns, angiography proves itself  to be very useful in both diagnosis and the management of an  individual retinal disorder. Fluorescein angiography is also vital in identifying areas which require  treatment, such as in disciform macular degeneration , and also is essential in evaluating  the response to the  treatment and the  necessity of retreatment .

Phases of the normal angiogram:

1 -Prearterial phase.

2 -Arterial phase.

3 -Arteriovenous ( capillary ) phase.

4 -Venous phase.

Abnormal features on fluorescein angiography:

Masking: any structure that lies in front of the retina or choriodal circulation will result in masking .  May be produced by (hemorrhage, pigment, exudate or fluid)

Masking by hemorrhage.                                                             Masking by Retinal Ischemia (Capillary non perfusion ) 

Transmission defect: Any defect in the  pigment epithelium , which results in its thinning will show  the  choroidal circulation more readily and therefore , there will be  a hyper fluorescent area on the fluorescein angiogram. May be produced by (choroiditis, Laser, choroidal rupture, macular hole,high myopia,pale eyes )

Transmission defect in full thickness macular hole.

Filling defect: A filling defect may be present in either the retinal of choroidal circulation. May be produced by ( emboli gives filling defect ,Takayasu's disease gives delay in the filling)

Filling defect and retinal Ischemia in Coats Retinal telangictasis.

Staining: Staining is the accumulation of dye within a structure which persist after the transit of the dye ,clearly indicating some damage to the tight junction of  the retinal pigment epithelium. May  be produced by ( Drusen)

The drusen in this picture stained by the dye with more staining  in late pictures.

Leakage: Progressive leakage of Fluorescein dye , out of the retinal circulation or optic disc, persists long after transit of the dye, may produced by (diabetic retinopathy,macroanurysm, CSCR)

Leakage in the  proliferative diabetic retinopathy. 

Leakage in the CSCR.(Central Serous Chorioretinopahty)

Pooling: Pooling of dye is the consequence of the leakage and is most characteristic of lesions, (such as central serous retinopathy and pigment epithelial detachment, where large fluid-filled spaces gradually fill with Fluorescein during and  following the angiogram )

Pooling in the RPE detachment in patient having  ARMD( age related macular degeneration ).