Fluorescein Angiography (Eye Fundus)

Norm of Fluorescein Angiography (Eye Fundus)

No leakage of dye from blood vessels of the retina during any of the following phases.
Filling stage
Begins 12–15 seconds after dye injection; noted when retinal vessels begin filling with dye.
Choroidal flush
The retina fluoresces and appears evenly mottled throughout the capillaries.
Arterial stage
Noted when arteries begin to fill with dye.
Arteriovenous stage
Noted when arteries have filled with dye and veins begin to fill with dye.
Venous stage
The arteries have emptied, and the veins have become filled and then emptied.
Late stage
½ to 1 hour after injection, the dye has circulated throughout the body, and recirculation of the retinal vessels can be seen.

 

Usage of Fluorescein Angiography (Eye Fundus)

Evaluation of retinopathy, tumors, retinal circulation abnormalities (occlusion, stenosis, dilatation, aneurysm, arteriovenous shunt), or papilledema. Identification of leakage and retinal thickening for subsequent laser treatment.

 

Description of Fluorescein Angiography (Eye Fundus)

A radiographic examination of the retinal vasculature after rapid injection of fluorescein dye. Fluorescein angiography provides rapid and direct acquisition of sequential images of the vasculature and the ability to manipulate the fluorescein images with the computer. For example, the processor can adjust for fluorescein leakage into the vitreous, cataracts, or cloudy corneas. It also provides the ability to display fluorescein images and color fundus images for comparison during laser treatment. The rapidly available images are also used to help explain the disease process to the client being examined.

 

Professional Considerations of Fluorescein Angiography (Eye Fundus)

Consent form IS required.

Risks
Allergic reaction (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), or seizure reaction to sodium fluorescein.
Contraindications
Previous allergy to sodium fluorescein; clients who are unable to keep their eyes open for the test.
Precautions
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk:benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative doseequivalent to an embryo/ fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/ radiology department to obtain estimated fetal radiation exposure from this procedure.

 

Preparation

1. Obtain mydriatic eyedrops and 5% or 10% sodium fluorescein.
2. Administer mydriatic eyedrops as prescribed 15–30 minutes before the test.
3. Insert a heparin lock intravenously.
4. Have emergency equipment, including diazepam or phenytoin, available in case of allergic or seizure reaction.
5. Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.

 

Procedure

1. Dilating eyedrops are administered.
2. The client's chin and forehead rest against the fundus camera, and one arm is extended to the side.
3. The client is instructed to open the eyes very wide, close the mouth, and look forward. The client can blink normally.
4. Baseline fundus photographs are taken.
5. Fluorescein dye is injected quickly and may cause facial flushing or nausea.
6. Photographs of the fundus of the eye are taken every second for 25–45 seconds. Late-phase photographs are taken 30 minutes later, if needed.

 

Postprocedure Care

1. Discontinue the heparin lock.

 

Client and Family Teaching

1. Clients with glaucoma should omit mydriatic eyedrops the day of the test.
2. Do not drive for at least 2 hours after the test.
3. Protective eyewear may be necessary for at least 2 hours after the test if the environment is bright or sunny.
4. Yellow discoloration of the skin and urine is normally present for up to 2 days.

 

Factors That Affect Results

1. Cataracts may interfere with fundal view.

 

Other Data

1. None.