Year : 1984 | Volume
: 32 | Issue : 5 | Page : 418--420
Value of fluorescein angiography in clinical ophthalmology
IS Jain, MR Dogra, Amod Gupta, SP Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
I S Jain
Department of Ophthalmology, Postgraduate«SQ» Institute of Medical Education and Research, Chandigarh
|How to cite this article:|
Jain I S, Dogra M R, Gupta A, Dhir S P. Value of fluorescein angiography in clinical ophthalmology.Indian J Ophthalmol 1984;32:418-420
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Jain I S, Dogra M R, Gupta A, Dhir S P. Value of fluorescein angiography in clinical ophthalmology. Indian J Ophthalmol [serial online] 1984 [cited 2022 Jul 1 ];32:418-420
Available from: https://www.ijo.in/text.asp?1984/32/5/418/27527
Novotony and Alvis first described fluorescein angiography (FA) in normal retinal circulation. It was a major break through in the diagnostic techniques available for the study of various fundus diseases. It brings out details regarding optic nerve, retina and choroid with remarkable clarity. It also serves as permanent record for such diseases. Recently there has been a much debate over its utility., Purpose of the present study is to determine practical value of FA with regards to its role as diagnostic, confirmatory and prognostic indicator of various diseases in our country.
MATERIALS AND METHODS
We reviewed clinical records of patients who underwent FA from July 1980 to June 1983. 140 patients who had fairly complete clinical records and FA were subject of this study. They were divided into three major groups.
Group I:-Optic nerve diseases (34 patients)
Group II:-Retinal vascular diseases (44 patients)
Group III:-Predominately macular diseases (62 patients)
Clinical versus FA diagnosis was studied in all the three groups.
Group I [Table 1]:• Of the 34 patients of optic nerve disease 20 had been referred by neurologist with diagnosis of suspected papilloedema. On FA 15 of the 20 were normal, three had definite disc oedema and two were still equivocal. One of the seven patients of definite disc oedema showed features of (anterior ischaemic optic neuropathy) AION on FA. Of the three cases of clinically AEON one showed optic disc oedema suggesting papillitis. Out of two cases of clinical papillitis, one had changes suggestive of AION on FA.
Group II [Table 2]: 18 patients of Venous occulusions were confirmed on FA in this group. Four of the eight clinically diagnosed new vessels turned out to be collaterals and one out of the two collaterals was found to be new vessels on FA. Non-perfusion areas and broken foveal arcade were observed in two and one patient respectively.
Of the ten patients of diabetes mellitus six had retinopathy clinically. No additional information could be obtained on FA except in one patient where retinopathy changes were visible on FA only.
11 patients of Eales disease were confirmed on FA. Of the six patients of active vasculitis two were found to be. healed whereas activity was seen in one of the two healed clinical vasculitis patients. Out of the eight patients showing new vessels clinically two turned out to be shunt vessels on FA.
Group III [Table 3]: 62 patients of predominately macular diseases were analysed in this group. Of the 11 cases of clinically central serous retinopathy (CSR) one had APMPPE and another Juvenile disciform macular degeneration on FA- Of the five clinically active CSR two were seen to be healed whereas one of the four healed lesions turned to be active.
Sub retinal neovascularisation was demonstrated in disciform macular degeneration on FA only. Four of the ten senile macular degeneration and three of the six clinical macular oedema showed no change on FA. No additional features could be observed in heredomacular degeneration, V.KH. Syndrome, A.P.M.P.P.E. and Choroditis.
Present study reveals that FA has mostly helped as an aid to diagnosis or method of confirmation. FA has helped in reaching a correct diagnosis in patients of doubtful disc oedema.5 This was seen in 15 of the 20 patients showing normal fluorescein pattern. Certain patients may have equivocal picture on FA and it may be difficult to differentiate papilloedema from pseudopapilloedema in such patients.5 These changes suggest that clinical examination alone may diagnose papilloedema in most of the patients. FA is required to clear confusion between AION and papillitis. This study shows that FA is must for diagnosis of AION.
Major contribution of FA is to differentiate new vessels from collaterals. This confusion was cleared in five out of ten patients in venous occlusions and two out of eight patients in Eale's diseases. This helps in subjecting new vessel areas to photocoagulation. Presence of non perfusion areas and broken foveal arcade are dermonstrated on FA and these are indicators of poor prognosis 6 FA is probably overused and is not required for practical management of diabetic retinopathy 4 No additive information could be obtained in ten patients of diabetes mellitus except for picking up back ground retinopathy in one case.
It does help to differentiate active and healed lesion in fundus. Diagnosis of active or healed lesion was revised after FA in three patients each of Eale's disease and CSR This serves as a marker for improvement after treatment. Presence of subretibal neovascularisation and pigment epithelial deffects in macular degeneration helps us as an aid in diagnosis, management and prognosis of such patients. Clinical examination is better than FA in senile macular degeneration as four of the 14 patients had no abnormalities on FA. It also serves as an aid to diagnosis and reveal activity in cases of V.KH. Syndrome. A.P.M.P.P.E. and choroditis patients.
|1||Novotony H.R., and Alvis D.L., 1961. Circulation 26:82.|
|2||Rosen E.S., 1969. Fluorescein Photography of the Eye, Butter Worths, London.|
|3||Norton E.W.D., 1981. Trans. Ophthalmol. Soc. U.K., 101: 229.|
|4||Peter H. Morse., 1979. Current Concepts in Ophthalmol., 6: 42.|