蛍光眼底観察法、蛍光眼底観察
WordNet
- a yellow dye that is visible even when highly diluted; used as an absorption indicator when silver nitrate solution is added to sodium chloride in order to precipitate silver chloride (turns pink when no chloride ions are left in solution and negative fluorescein ions are then absorbed) (同)fluoresceine, fluorescent_dye, resorcinolphthalein
- roentgenographic examination of blood vessels after injection of a radiopaque contrast medium; produces an angiogram
- exhibit or undergo fluorescence
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Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/25 15:31:28」(JST)
[Wiki en表示]
| Fluorescein angiography |
| Intervention |
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Retina during the effects of fluorescein angiography
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| ICD-9-CM |
95.12 |
| MeSH |
D005451 |
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[edit on Wikidata]
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Intravenous Fluorescein angiography (IVFA) or Fluorescent Angiography (FAG) is a technique for examining the circulation of the retina and choroid using a fluorescent dye and a specialized camera. It involves injection of sodium fluorescein[1] into the systemic circulation, and then an angiogram is obtained by photographing the fluorescence emitted after illumination of the retina with blue light at a wavelength of 490 nanometers. The test uses the dye tracing method.
The fluorescein dye also reappears in the patient urine, causing the urine to appear darker, and sometimes orange.[2] It can also cause discolouration of the saliva.
Fluorescein angiography is one of several health care applications of this dye, all of which have a risk of severe adverse effects. See fluorescein safety in health care applications. Fluorescein angiography does not involve the use of ionizing radiation.[3]
Contents
- 1 Equipment
- 2 Technique
- 3 Normal circulatory filling
- 4 Pathologic findings
- 5 Other types of fluorescent angiography
- 6 See also
- 7 References
- 7.1 Additional references
Equipment
- Exciter filter: Allows only blue light to illuminate the retina. Depending on the specific filter, the excitation wavelength hitting the retina will be between 465-490 nm. Most only allow light through at a wavelength of 490 nm.
- Barrier filter: Allows only yellow-green light (from the fluorescence) to reach the camera. Both filters are interference bandpass filters, which means they block out all light except that at a specific wavelength. The barrier filter only allows light with a wavelength of 525 nm, but depending on the filter it can be anywhere from 520-530 nm.
- Fundus Camera, either digital or with camera body containing black and white, or slide positive film.
Technique
- Baseline color and black and white red-free filtered images are taken prior to injection. The black and white images are filtered red-free (a green filter) to increase contrast and often gives a better image of the fundus than the color image.
- A 6-second bolus injection of 2-5cc of sodium fluorescein into a vein in the arm or hand.
- A series of black-and-white or digital photographs are taken of the retina before and after the fluorescein reaches the retinal circulation (approximately 10 seconds after injection). The early images allow for the recognition of autofluorescence of the retinal tissues. Photos are taken approximately once every second for about 20 seconds, then less often. A delayed image is obtained at 5 and 10 minutes. Some doctors like to see a 15-minute image as well.
- A filter is placed in the camera so only the fluorescent, yellow-green light (530 nm) is recorded. The camera may however pick up signals from pseudofluorescence or autofluorescence. In pseudofluorescence, non-fluorescent light is imaged. This occurs when blue light reflected from the retina passes through the filter. This is generally a problem with older filters, and annual replacement of these filters is recommended. In autofluorescence, fluorescence from the eye occurs without injection of the dye. This may be seen with optic nerve head drusen, astrocytic hamartoma, or calcific scarring.
- Black-and-white photos give better contrast than color photos, which aren't necessary since only one color is being transmitted though the filter.
Normal circulatory filling
times are approximate
- 0 seconds — injection of fluorescein
- 9.5 sec — posterior ciliary arteries
- 10 sec — choroidal flush (or "pre-arterial phase")
- 10-12 sec — retinal arterial stage
- 13 sec — capillary transition stage
- 14-15 sec — early venous stage (or "laminar stage", "arterial-venous stage")
- 16-17 sec — venous stage
- 18-20 sec — late venous stage
- 5 minutes — late staining
Fluorescein enters the ocular circulation from the internal carotid artery via the ophthalmic artery. The ophthalmic artery supplies the choroid via the short posterior ciliary arteries and the retina via the central retinal artery, however, the route to the choroid is typically less circuitous than the route to the retina. This accounts for the short delay between the "choroidal flush" and retinal filling.
Pathologic findings
Pathologic changes are recognized by the detection of either hyperfluorescence or hypofluroescence.
Causes of hyperfluorescence:
- window/transmission (filling) defects
- leaking defects (i.e. capillary leakage, aneurysm, neovascularization)
- pooling defects
- staining
- abnormal vasculature
Causes of hypofluorescence:
- blocking defect (i.e. blood)
- filling defect (capillary nonperfusion/blockage)
Fluorescein angiography is used by physicians specializing in the treatment of eye diseases (ophthalmologists) to evaluate the vasculature of the retina, choroid, optic disc, and iris.[3] Among the common groups of ophthalmologic disease, fluorescein angiography can detect diabetic retinopathy (neovascularization), vein occlusions, retinal artery occlusions,[4] edema of the optic disc, and tumors. Additionally, the transit time (the period between injection of the dye and when it appears in the examined blood vessels) can provide an objective measurement of the rate of blood flow through the imaged blood vessels.[3]
Other types of fluorescent angiography
- Indocyanine green angiography
See also
References
- ^ Fluorescein Angiography at the US National Library of Medicine Medical Subject Headings (MeSH)
- ^ "Fluorescein angiography". U.S. National Library of Medicine. MedLine Plus. Retrieved 14 December 2012.
- ^ a b c Kunimoto, Derek; Kunal Kanitkar; Mary Makar (2004). The Wills eye manual: office and emergency room diagnosis and treatment of eye disease. (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. p. 365. ISBN 978-0781742078.
- ^ Kumar, Vinay (2007). "Chapter 29: Eye, Retina and Vitreous, Retinal Vascular Disease". Robbins basic pathology (8th ed.). Philadelphia: Saunders/Elsevier. ISBN 978-1416029731.
Additional references
- Gisbert, Gisbert Richard; Gisele Soubrane; Lawrence Y. Yannuzzi (1998). Fluorescein angiography: textbook and atlas (2nd rev. and expanded ed.). Stuttgart: Thieme. ISBN 0-86577-712-8.
- Kanski, Jack J. (2003). Clinical ophthalmology: a systematic approach (5. ed.). Edinburgh: Butterworth-Heinemann. ISBN 978-0750655415.
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Eye surgery and other procedures (ICD-9-CM V3 08–16+95.0–95.2, ICD-10-PCS 08)
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| Adnexa |
| Eyelids |
- Blepharoplasty
- East Asian blepharoplasty
- Epicanthoplasty
- Tarsorrhaphy
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| Lacrimal system |
- Dacryocystorhinostomy
- Punctoplasty
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| Globe |
| Cornea |
- Radial keratotomy
- LASIK
- Keratomileusis
- Epikeratophakia
- Corneal transplantation
- Photorefractive keratectomy
- Mini asymmetric radial keratotomy
- Intracorneal rings
- Corneal collagen cross-linking
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Iris, ciliary body,
sclera, and anterior chamber |
- Glaucoma surgery: Trabeculectomy
- Iridectomy
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| Lens |
- Phacoemulsification
- Cataract surgery
- Capsulorhexis
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Retina, choroid,
vitreous, and posterior chamber |
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| Orbit and eyeball |
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| Extraocular muscles |
- Harada–Ito procedure
- Strabismus surgery
- Botulinum toxin therapy of strabismus
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| Medical imaging |
- Fluorescein angiography
- Fundus photography
- Corneal topography
- Optical coherence tomography
- Electrodiagnosis: Electrooculography
- Electroretinography
- Electronystagmography
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| Eye examination |
- Gonioscopy
- Dilated fundus examination
- Ocular tonometry
- Ophthalmoscopy
- Retinoscopy
- Color perception test
- Visual field test/Perimetry
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| Radiotherapy |
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Vascular surgery ICD-9-CM V3 38–39, ICD-10-PCS 03–6
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Vascular and
Endovascular surgery |
| Arterial disease |
- Vascular bypass
- Angioplasty
- Atherectomy
- Endarterectomy
- Stenting
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| Venous disease |
- Ambulatory phlebectomy
- Laser surgery
- Sclerotherapy
- Vein stripping
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| Arterial and Venous Access |
- Venous cutdown
- Arteriotomy
- Phlebotomy
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| Aortic aneurysm / dissection: |
- Endovascular aneurysm repair
- Open aortic surgery
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| Other |
- Cardiopulmonary bypass
- Cardioplegia
- Extracorporeal membrane oxygenation
- Hemodialysis
- Revascularization
- Glomectomy
- First rib resection
- Seldinger technique
- Vascular snare
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| Medical imaging |
| Angiography |
- Digital subtraction angiography
- Cerebral angiography
- Aortography
- Fluorescein angiography
- Radionuclide angiography
- Magnetic resonance angiography
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| Venography |
- Portography
- Impedance phlebography
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| Ultrasound |
- Intravascular ultrasound
- Carotid ultrasonography
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| Other diagnostic |
- Angioscopy
- Ankle brachial pressure index
- Tilt table test
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Medical imaging (ICD-9-CM V3 87–88, ICD-10-PCS B, CPT 70010–79999)
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X-ray/
medical radiography/
Industrial radiography |
| 2D |
| Medical: |
- Pneumoencephalography
- Dental radiography
- Sialography
- Myelography
- CXR
- AXR
- KUB
- DXA/DXR
- Upper gastrointestinal series/Small-bowel follow-through/Lower gastrointestinal series
- Cholangiography/Cholecystography
- Mammography
- Pyelogram
- Cystography
- Arthrogram
- Hysterosalpingography
- Skeletal survey
- Angiography
- Angiocardiography
- Aortography
- Venography
- Lymphogram
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| Industrial: |
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| 3D / XCT |
| Medical: |
- CT pulmonary angiogram
- Computed tomography of the heart
- Computed tomography of the abdomen and pelvis
- CT angiography
- Computed tomography of the head
- Quantitative computed tomography
- Spiral computed tomography
- High resolution CT
- Whole body imaging
- X-ray microtomography
- Electron beam tomography
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| Industrial: |
- Industrial computed tomography
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| Other |
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| MRI |
- Magnetic resonance imaging of the brain
- MR neurography
- Cardiac MRI/Cardiac MRI perfusion
- MR angiography
- MR cholangiopancreatography
- Breast MRI
- Functional MRI
- Diffusion MRI
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| Ultrasound |
- Echocardiography
- Doppler echocardiography
- Intravascular
- Gynecologic
- Obstetric
- Echoencephalography
- Transcranial Doppler
- Abdominal ultrasonography
- Transrectal
- Breast ultrasound
- Transscrotal ultrasound
- Carotid ultrasonography
- Contrast-enhanced
- 3D ultrasound
- Endoscopic ultrasound
- Emergency ultrasound
- FAST
- Pre-hospital ultrasound
- Duplex
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| Radionuclide |
| 2D / scintigraphy |
- Cholescintigraphy
- Scintimammography
- Ventilation/perfusion scan
- Radionuclide ventriculography
- Radionuclide angiography
- Radioisotope renography
- Sestamibi parathyroid scintigraphy
- Radioactive iodine uptake test
- Bone scintigraphy
- Immunoscintigraphy
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| full body: |
- Octreotide scan
- Gallium 67 scan
- Indium-111 WBC scan
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| 3D / ECT |
- SPECT
- gamma ray: Myocardial perfusion imaging
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| PET (positron): |
- Brain PET
- Cardiac PET
- PET mammography
- PET-CT
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| Optical laser |
- Optical tomography
- Optical coherence tomography
- Confocal microscopy
- Endomicroscopy
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| Thermography |
- non-contact thermography
- contact thermography
- dynamic angiothermography
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UpToDate Contents
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English Journal
- Effect of charred Radix et Rhizoma Rhei in a laser-induced choroidal neovascularization murine model.
- Han D1, Yao Y1, Sun Y1, Gong Y1, Wu X1.
- Molecular medicine reports.Mol Med Rep.2015 Apr;11(4):2896-902. doi: 10.3892/mmr.2014.3046. Epub 2014 Dec 4.
- A pharmaceutical composition (patent no. WO2012079419) exhibited favorable outcomes in a clinical trial of wet age‑related macular degeneration. The aims of the present study were to explore the effects of one composition component, charred Radix et Rhizoma Rhei (CRRR), in a laser‑induced choroi
- PMID 25482457
- Pigment epithelium-derived factor inhibits retinal microvascular dysfunction induced by 12/15-lipoxygenase-derived eicosanoids.
- Ibrahim AS1, Tawfik AM2, Hussein KA3, Elshafey S4, Markand S5, Rizk N6, Duh EJ7, Smith SB8, Al-Shabrawey M9.
- Biochimica et biophysica acta.Biochim Biophys Acta.2015 Mar;1851(3):290-298. doi: 10.1016/j.bbalip.2014.12.017. Epub 2015 Jan 3.
- We recently demonstrated that 12/15-lipoxygenase (LOX) derived metabolites, hydroxyeicosatetraenoic acids (HETEs), contribute to diabetic retinopathy (DR) via NADPH oxidase (NOX) and disruption of the balance in retinal levels of the vascular endothelial growth factor (VEGF) and pigment epithelium-d
- PMID 25562624
- Risk factors for geographic atrophy after intravitreal ranibizumab injections for retinal angiomatous proliferation.
- Cho HJ1, Yoo SG2, Kim HS2, Kim JH2, Kim CG2, Lee TG2, Kim JW2.
- American journal of ophthalmology.Am J Ophthalmol.2015 Feb;159(2):285-292.e1. doi: 10.1016/j.ajo.2014.10.035. Epub 2014 Nov 5.
- PURPOSE: To describe the risk factors for the development of geographic atrophy (GA) following intravitreal ranibizumab injection treatment for retinal angiomatous proliferation (RAP).DESIGN: Retrospective interventional series.METHODS: Forty-three eyes (38 South Korean patients) from patients being
- PMID 25447115
Japanese Journal
- 蛍光眼底造影と光干渉断層血管撮影 (特集 光干渉断層血管撮影(OCT angiography)のすべて)
- 臨床報告Selected 網脈絡膜疾患における光干渉断層血管撮影と蛍光眼底造影との有用性の比較
- Relationship between Functional and Structural Changes in Diabetic Vessels in Optical Coherence Tomography Angiography.
Related Links
- An abnormal value on a fluorescein angiography may be due to: Blood flow (circulatory) problems, such as blockage of the arteries Cancer Diabetic or other retinopathy High blood pressure Inflammation or edema Tumors Risks ...
- History Two medical students from Indiana University, H.R. Novotny and D.L. Alvis, described and demonstrated the technique of retinal fluorescein angiography (FA) in 1961. 1 Donald Gass began publishing his experience with FA ...
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