Indian Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 1984  |  Volume : 32  |  Issue : 5  |  Page : 415--417

Oral fluorescein angiography


Rajvardhan Azad, BK Nayak, HK Tewari, PK Khosla 
 Dr. Rajendra Prasad Centre for Ophthalmic Science. AIIMS, New Delhi, India

Correspondence Address:
Rajvardhan Azad
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi 110029
India




How to cite this article:
Azad R, Nayak B K, Tewari H K, Khosla P K. Oral fluorescein angiography.Indian J Ophthalmol 1984;32:415-417


How to cite this URL:
Azad R, Nayak B K, Tewari H K, Khosla P K. Oral fluorescein angiography. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 21 ];32:415-417
Available from: https://www.ijo.in/text.asp?1984/32/5/415/27526


Full Text

Fluorescein fundus angiography is an important diagnostic tool for retinal disor­ders[1] providing useful information regarding anatomical details of circulation and its functional integrity. The conventional fluorescein fundus angiography (using intra­venous route) poses a problem in group of patients psychologically or technically unsuitable for intravenous injection. Per oral fluorescein angiography, being a noninvasive technique, circumvents this problem. No study on oral fluorescein angiography has been reported from India.

 MATERIALS AND METHODS



20 patients subjected to per oral fluores­cein angiography were chosen from amongst the patients coming for intravenous angio­graphy at Dr. Rajendra Prasad Centre for Ophthalmic Sciences. Those (17 cases) who had late leakage, (staining or pooling) & in whom anatomic details of early phase were not critical and those (3 cases) in which intravenous procedures could not be done easily (too young or obese patients) and only late phases finding were conclusive, were taken up. The interval between the two procedures-Intravenous fluorescein angio­graphy and per oral fluorescein angiography was at least three days. Three normal individuals (volunteers) were also subjected for per oral fluorescein angiography as a pilot project to standardize the dosage of oral fluorescein sodium and to see the accep­tability of oral administration.

Patients were instructed to have a light meal at least two hours prior to the start of the test for better absorption of dye. One gram of fluorescein sodium-5 ml of 20% dye mixed in 200 ml of cola was given orally to patients upto 40 kgs. of body weight. The dose was increased to 1.5 g in patients with body weight upto 60 kgm while 2 g was given to patients over 60 kgm body weight.

Pre-administration colour photographs and control photographs using green filter were taken with Carl Zeiss fundus camera. Postadministration photographs using blue filter were taken at the 15, 30, 45, and 60 minutes intervals.

 RESULTS



Presence of dye (arteriovenous phase) could be demonstrated in the angiograms taken at about fifteen minutes which increased consequently and late staining or leakage as seen in intravenous technique could be visualised between 30-45 minutes. Comparison of findings between late frames of intravenous and oral fluorescein angio­graphy indicated that dye leakage is obtained in both although it is not as intense in the lat­ter as in the former.

[Table 1] and [Figure 1] (a) and (b) show that similar findings could be obtained on oral and intravenous route fluorescein angio­graphy. [Table 2] and [Figure 2] show that requisite findings could be obtained with oral fluores­cein angiography where intravenous administration of the dye was technically difficulty.

None of the subjects had any nausea, vomiting or any allergic reactions. Taste was well accepted by all the patients as the dye mixed well with coal.

 DISCUSSION



Per oral fluorescein angiography has been described by Kelley and Kincaid[2] but in our experience the dose of 10 m per 50 kgm body weight of the patient as described by these authors does not give satisfactory view of the dye. It was found that 1 G dose per 40 kgm body weight gave satisfactory result without any untoward effect. The dye is seen in about 15 minutes although various phases (arterial arteriovenous and venous) as delineated by the intravenous technique are not clearly seen in the oral method. So oral fluorescein angiography should not be the method of choice where early circulation dynamics and fine anatomical details are of prime importance.

Cases of various disorders as shown in [Table 2] indicate that late staining or pooling of dye could be seen by oral fundus fluores­cein angiography and the results were com­parable to late frames of intravenous angiograms. Hence we conclude that late staining or pooling could be clearly visualised in both although the intensity was not so much in the oral method hence it is a useful method where only documentation of the pre­sence or absence dye leakage in late frames of angiograms is needed.

[Table 2] shows satisfactory results in children and obese patients. In these situations, an oral route may be preferred i.e. when intravenous administration is techni­cally difficult. The conditions suitable for oral fluorescein angiography are only those where late dye leakage is expected e.g. macular oedema, including central serous retino­pathy, disciform degeneration, optic disc swelling, diabetic retinopathy, choroiditis, and Coat's disease.

The test is safer as oral route is always less dangerous than intravenous route. The sensa­tion of nausea is related to injection of dye in bolus, which is avoided by oral route of dye administration so absence of any side effect as seen in this limited study seems to be an added advantage.

References

1Novotony, H.R., and Alvis, D.L. 1961. Circulation 26:82.
2Kelley, J.S., Kincaid, M., Hoover, R.E., Mac. Beth., C., 1980. Jour. of Amer. Acad. of Ophthalmol., 87:805.