荧光素钠静脉过敏试验与皮肤过敏试验对FFA检查的安全性比较

荧光素眼底血管造影（fundus fluorescein angiography，FFA）过程中常出现不良反应，严重者可致过敏性休克。本文比较荧光素钠静脉过敏试验与皮肤过敏试验对FFA检查的安全性。     

Comparison of fundus fluorescein angiography and fundus photography grading criteria for early diabetic retinopathy

AIM:To compare the assessment outcomes of the characteristics of mild to moderate non-proliferative diabetic retinopathy(NPDR) established by fundus photography and fundus fluorescein angiography(FFA).METHODS:The fundus photos and FFA results of 260 patients with diabetes mellitus were reviewed.Diabetic retinopathy(DR) severity was graded based on the international classification standard.The microaneurysms,hemorrhages,and intraretinal microvascular abnormalities(IRMA) in FFA images of patients with mild to moderate NPDR were observed.The differences between the fundus photos and the FFA results were summarized,analyzed,and compared.RESULTS:The counting of intraretinal hemorrhages identified by FFA revealed that only 9 eyes(1.9%) had more than 20 intraretinal hemorrhages in all four quadrants;15 eyes(3.1%) had more than 20 intraretinal hemorrhages in three quadrants;26 eyes(5.4%) had over 20 intraretinal hemorrhages in two quadrants;and 37 eyes(7.7%) had more than 20 intraretinal hemorrhages in only one quadrant.Furthermore,the number of IRMAs appeared ≥4 in 17 eyes,3 in 35 eyes,2 in 69 eyes,and 1 in 93 eyes.CONCLUSION:FFA has higher detection accuracy of retinal angiopathy than fundus photography.FFA grading results are helpful for timely detection and proper treatment of lesions easily missed by fundus photography.     

Changes of Indocyanine Green and Fluorescein Angiography in Multiple Evanescent White-dot Syndrome： A Case Report

Purpose:To study the clinicopathological change on "Multiple Evanescent White-dot Syndrome (MEWDS)" through fundus angiogrphy analyses.Methods:Examing the case with fluorescein angiography (FFA) and indocyanine green angiography(ICGA), visual field and following up for 15 months.Results:There exist multiple white dots in the fundus photo and angiography. The changes on ICGA maintain longer than fundus photo and FFA. Papille may be edematous and macula could present with special hypofluorescent flecks.Conclusions:MEWDS has specific angiographic features. Its pathological changes involve deep retinal pigment epithelium(RPE) as well as choroidal capillaries. The prognosis of the visual acuity for MEWDS is very good. Eye Science 2003;19:171-173.     

酒精性过敏患者眼底荧光血管造影不良反应分析

目的 观察酒精性过敏患者行FFA检查时不良反应情况,为临床安全应用该检查做出评估与参考.方法 回顾性分析我科近4年行FFA检查患者,把酒精性过敏、药物过敏患者及对照组患者在行该检查时出现的不良反应分为轻、中、重度,通过统计学分析三组间的差异.结果 酒精性过敏患者FFA检查发生不良反应率100%,且多为中度反应,其发生率明显高于其他组(P<0.05).药物过敏组及对照组发生不良反应率相似(P>0.05).结论 对于酒精性过敏患者行FFA检查风险较大,临床上针对该类患者检查时宜慎重,应充分与患者及家属说明情况,并做好完善的抢救准备,及时处理不良反应的发生.     

Neovascular Glaucoma in a Patient with X-linked Juvenile Retinoschisis

Purpose: To report the rubeosis iridis and neovascular glaucoma findings in one patient of X-linked juvenile retinoschisis(XLRS). Methods: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan were performed in a patient with X-linked juvenile retinoschisis complicated with neovascular glaucoma. Result: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan unveiled a rare condition of XLRS complicated with neovascular glaucoma. Conclusion: XLRS may complicate with neovascular glaucoma. It is necessary to test OCT, FFA, ERG and carefully examine the fundus of the follow eye when it comes to uncertain neovascular glaucoma of youth and child. And only in this way, can we exclude XLRS. Eye Science 2005; 21:140-141.     

Clinical Features and Differential Diagnosis of Acute Idio-pathic Blind Spot Enlargement Syndrome

Purpose： To study the clinical manifestations and the diag- nostic and differential diagnostic characteristics of acute idio- pathic blind spot enlargement syndrome （AIBSES）. Methods： Six patients diagnosed with AIBSES underwent complete eye examinations including fundus photography, fundus fluorescein angiography（FFA）, indocyanine green an- giography （ICGA）, optical coherence tomography （OCT）, electroretinogram （ERG）, and visual field examinations. Results： All patients had enlarged blind spots of variable sizes and densities. Three eyes had mild swelling of the optic disc and one eye had peripapillary scarring that corresponded to the permanent field defect. Two patients who underwent FFA had fluorescein leakage of blood vessels around the optic disc and ICGA highlighted diffuse, small hypofluorescent spots scatter- ing throughout the posterior pole. OCT showed that the inner and outer segment （IS/OS） line were absent in five patients and the middle cone outer segment tip line was absent in the nasal macular area in one eye.     

Characteristics of Indocyanine Green Angiography in Exudative Age—related Macular Degeneration

Objective: To observe the characteristics of indocyanine green angiography (ICGA) in exudative age-related macular degeneration (AMD).Methods: Thirty-one cases (39 eyes) were diagnosed as exudative AMD by ocular examination, fundus color photography, fundus fluorescein angiography (FFA) and ICGA. Their ages ranged from 50 to 82 years and visual acuities from FC/30cm to 0. 7. We analyzed and compared the characteristics of ICGA and FFA in these patients. Results: Of 26 eyes with occult choroidal neovascularization (CNV) by FFA, 15 (57. 7% ) had classic CNV by ICGA. Of 4 eyes with serous retinal pigment epithelial detachment (FED) without CNV by FFA, 1 had serous FED with classic CNV by ICGA. The hyperfluorescence of the scar staining was detecfed by ICGA. Conclusion ? ICGA adds clinically useful information and is an important adjunct in the evaluation, classification, and laser treatment of patients with occult CNV in AMD. Eye Science 1999; 15: 156 - 161.     

Lipofuscin-and Melanin-related Fundus Autofluorescence in Patients with Submacular Idiopathic Choroidal Neovascularization

Purpose:.To compare melanin-related near-infrared fundus autofluorescence (NIA; excitation 787 nm, emission> 800 nm) with lipofuscin-related fundus autofluorescence (FAF; excitation 488 nm, emission > 500 nm) in patients with idiopathic choroidal neovascularization (ICNV). Methods: FAF, NIA, fundus fluorescein angiography (FFA) and indocyanine green angiography.(ICGA).were obtained using a confocal scanning laser Ophthalmoscope HRA2 (Heidelberg Retina Angiograph 2).in 18 eyes of 18 patients with ICNV. Results:.Eighteen eyes had classic CNV, and autofluorescence imaging showed hypoautofluorescence at the site of CNV..A well-defined hyperautofluorescent ring was detected surrounding the CNV in all 18 eyes with NIA imaging. In our sample,.the FAF patterns around the CNV were classified as normal (n=1,.5.56%), well-defined hyperautofluorescent ring (n=7,.38.89%), or ill-defined hyperautofluorescent ring (n=10, 55.56%). Conclusion:.The patterns of FAF and NIA indicated different involvement of lipofuscin and melanin in the pathophysiological process of ICNV. Compared to FAF imaging, NIA imaging appears to be a superior noninvasive method for in vivo visualization of retinal pigment epithelium (RPE) abnormalities in ICNV patients.     

原田病药物治疗后吲哚青绿眼底血管造影观察

目的 探讨利用吲哚青绿血管造影检查作为原田(Harada)病临床观察指标的意义.方法 对经药物治疗后19例(38只眼)原田病患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)检查资料进行分析.结果 FFA检查发现有4例(8只眼)视盘轻度染色,视网膜未发现异常改变;ICGA早期及中期无异常表现,但后期8只眼(包括FFA中视盘染色的4只眼)在中周及后极部出现了点状或斑片状弱荧光;3例6只眼FFA及眼底正常,在ICGA后期后极部出现了斑点状弱荧光;24只眼脉络膜大、中血管影像减少,其中12只眼dalen-fuchs结节着色.结论 ICGA可较好提供原田病的脉络膜循环损害的信息,并在评价疗效上有意义.

Abstract：

Objective To investigate the clinical value of indocyanine green angiography(ICGA)in patients with Harada disease.Methods Fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were used for comparative analyses in 26 cases(52 eyes)of Harada disease after treatment.Results Mild dyeing in disk was found only in 4 cases(8 eyes),and the others were not found any abnormal in FFA.There were no any abnormal found in early period and middle period of ICGA,but of 8 eyes(include 4 eyes of dyeing in disk in FFA)multifocal lower fluorescence were found in the mid-periphery and posterior pole of the fundus in the late phase.Of 3 cases(6 eyes)were normal in FFA,however multifocal lower fluorescence were found in the posterior pole of the fundus in the late phase of ICGA.Of 24 eyes were found decreased fluorescence in large and middle choroidal vessel,and 12 eyes of Dalen-Fuchs were colored.Conclusions ICGA may assist in providing valuable information on choroidal circulation of Harada disease and be useful in evaluating the curative effects.     

Risk factors for adverse reactions of fundus fluorescein angiography

Background: To explore the difference between the outcomes of correlations between a series of variables and adverse reactions (ARs) to fluorescein from univariate and multivariate analysis and to evaluate the nausea effects in different age groups. Methods: A retrospective study of patients undergoing consecutive lfuorescein angiography between March 2010 and February 2012 was conducted. No patients were excluded on the ground of age, presence of atopy, allergy history, previous procedures without severe allergic ARs, asymptomatic hypertension and kidney failure with serum creatinine levels lower than 250 μmol/L or with renal dialysis. Results: A total of 829 patients were enrolled and 22.2% of them had ARs. The majority of reactions were nausea (12.1%) which occurred less when age became old (P<0.0001). When the correlations between a series of variables and ARs were assessed separately, age (P<0.0001), prior reactions (P<0.0001) and motion sickness (P=0.0062) were highly and cardio/cerebrovascular disease (P=0.0015), diabetes (P=0.0001) and renal disease (P=0.0219) were lowly related to ARs. However, when the correlations were assessed simultaneously, only age [odd ratio (OR) 0.974; 95% conifdence interval (CI), 0.962–0.986], prior reactions (OR 5.596; 95% CI, 2.083–15.029) and motion sickness (OR 4.849; 95% CI, 1.583–14.856) were statistically correlated with ARs. Conclusions: Fluorescein angiography is a safe procedure for patients who are relatively healthy but with a history of any systemic disease. Young age, prior reactions and motion sickness which are highly related to emetic events should be considered in the evaluation of ARs to lfuorescein.     

眼底荧光血管造影不良反应与药物过敏史的关系

目的:分析行眼底血管荧光造影(fundus fluorecein angiography,FFA)静脉注射荧光素钠不良反应的发生率与既往药物过敏史情况之间的关系。方法:观察160例既往有药物过敏史患者及160例既往无药物过敏史患者静脉注射荧光素钠进行FFA时不良反应的发生率,分析不良反应发生率与既往药物过敏史情况的关系。结果:160例有药物过敏史的患者静脉注射荧光素钠后发生不良发应17例(10.6%),160例无药物过敏史的患者静脉注射荧光素钠后发生不良发应15例(9.4%)。不良反应主要为恶心、呕吐、头晕等不适,无心脏骤停、过敏性休克等危及生命的严重反应。统计学分析两组患者之间静脉注射荧光素钠后不良反应发生率的差异无明显统计学意义(χ2=0.165,P>0.05)。结论:FFA静脉注射荧光素钠不良反应的发生率与既往有无药物过敏史没有明显的相关性,药物过敏史患者不是行FFA检查的禁忌证。     

Temperature effect on nausea during fluorescein angiography.

PURPOSE: Nausea is the most common adverse effect of fluorescein angiography (FA). Warming of fluorescein dye before injection has been reported anecdotally to decrease nausea frequency. We examined the effect of warmed fluorescein dye on the frequency of adverse effects of FA. DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS: Five hundred forty-seven angiograms performed on 394 patients; 273 were in the control group and 274 were in the study group. METHODS: Patients were alternately assigned to FA using dye at room temperature (control group) or dye prewarmed to body temperature (study group). All patients were masked to the dye temperature. After FA, patients were questioned regarding any adverse effects experienced. MAIN OUTCOME MEASURES: Presence or absence of reported nausea associated with FA. RESULTS: Adverse reactions were reported for 39 of the angiograms (7.1%), including 32 procedures for which nausea was reported (5.9%). No significant difference in the frequency of adverse reactions was found between the two groups (P = 0.41). No significant difference in the frequency of nausea was found between the two groups (P = 0.28). The sample sizes used allow an 80% power for detecting a clinically significant difference of 4% adverse effects in one group and 10% in the other group when testing at a significance level of 5%. CONCLUSIONS: Warming of fluorescein dye does not significantly alter the incidence of nausea reported with FA.     

耳穴压豆预防眼底荧光血管造影胃肠反应的效果观察

目的:探讨耳穴压豆疗法预防眼底荧光血管造影(fluorescence fundus angiography,FFA)胃肠反应的效果。方法:选取2019年10月至2020年4月在汕头大学·香港中文大学联合汕头国际眼科中心特殊检查科行眼底荧光素血管造影检查的患者583例,试验组298例,对照组285例。对照组在检查前予常规护理措施。试验组检查前在对照组的基础上实施耳穴压豆疗法。比较两组受检者在检查期间的胃肠道反应情况及配合度和舒适度的区别。结果:试验组胃肠道反应发生率低于对照组(P<0.05)。配合度得分试验组为(2.87±0.35)分,对照组为(2.96±0.19)分,两组差异有统计学意义(P<0.001)。舒适度得分试验组为(3.93±0.70)分,对照组为(3.91±0.56)分,两组差异无统计学意义(P=0.122)。结论:耳穴压豆疗法可以降低FFA检查胃肠道反应发生率,疗效安全可靠,操作简便易行,另外,耳穴压豆方法不会造成患者检查时舒适度下降,有助于患者顺利安全完成检查。     

Allergy skin testing in predicting adverse reactions to fluorescein: a prospective clinical study

Purpose: To evaluate allergy skin testing as a diagnostic tool of adverse reactions to fluorescein and whether allergy and previous sodium fluorescein angiography (SFA) act as predisposing factors. Methods: Patients with adequate indication for fluorescein angiography and normal skin responsiveness were subjected to allergy skin‐prick and intradermal tests for fluorescein, followed by SFA. During SFA, adverse reactions were monitored and classified as mild, moderate or severe. Previous SFAs and adverse reactions as well as the presence of atopy were also registered. Results: One thousand and thirty‐seven patients were enrolled in the study and 1284 SFAs were executed. Forty‐four patients (4.3%) developed 55 adverse reactions; among them 50 (3.8%) were mild, three (0.2%) moderate and two (0.16%) severe. None of the reactors produced positive skin tests to fluorescein. Patients with atopy and previous SFAs were not more susceptible to adverse reactions. Conclusion: The vast majority of adverse reactions to fluorescein are mild and not attributed to immunological mechanisms. Allergy skin tests cannot predict non‐immunological reactions but their utility remains substantial in predicting anaphylaxis during SFAs and must be performed in patients reporting risk factors in their past medical history.     

Adverse reactions to fluorescein angiography: A comprehensive review of the literature

We reviewed literature on adverse reactions to intravenous fluorescein angiography using PubMed and found 78 articles in English from 1961 to 2017. The reported rates of adverse reactions were overall 0.083–21.69%, separated into mild (1.24–17.65%), moderate (0.2–6%), and severe (0.04–0.59%). There were 1:100,000 to 1:220,000 deaths. Fluorescein concentration, volume injected, speed of injection, temperature, and contaminants were not correlated with the incidence of reactions. Patient characteristics including other comorbid diseases, allergy history, age, race, and gender showed only an increased rate of reaction in patients with a history of reaction to fluorescein. Although a number of studies examine techniques to reduce adverse reactions to intravenous fluorescein angiography, to date, the only proven method is reviewing allergy history, specifically a history of previous reaction to fluorescein.     

Adverse reactions in intravenous fluorescein angiography

Adverse reactions were noted in 241 (4.82%) of 5,000 consecutive intravenous fluorescein angiographies of the retina. The most frequent adverse reactions were nausea (2.24%), vomiting (1.78%), and urticaria/pruritus (0.34%). No life-threatening reactions were noted. No significant difference in the rate of adverse reactions was found when angiography using 10% fluorescein was compared with angiography using 25% fluorescein.     

血栓通联合羟苯磺酸钙治疗糖尿病视网膜病变导致的视野缺损

目的:探讨血栓通联合羟苯磺酸钙应用于糖尿病视网膜病变导致的视野缺损的临床疗效.方法:选取我院收治的糖尿病视网膜病变患者64例作为研究对象,将其随机均分为观察组和对照组,对照组采用血栓通进行治疗,观察组在上述治疗的基础上加用羟苯磺酸钙进行联合治疗.治疗5 mo后,比较两组糖尿病视网膜病变患者的临床疗效,治疗前后视野、荧光造影及眼底照相变化情况,观察患者的不良反应及复发情况.结果:两组患者的病情均明显好转,且观察组患者治疗有效率为97％,高于对照组的78％,差异比较有统计学意义(P＜0.05);观察组患者出血斑明显降低治疗前后比较有显著性差异,具有统计学意义(P＜0.05),观察组的视野灰度值、出血斑、血管瘤变化情况均明显优于对照组,具有统计学意义.观察组患者未出现不良反应,且复发率明显少于对照组,复发率比较有显著性差异(P＜0.05).结论:血栓通联合羟苯磺酸钙对糖尿病视网膜病变患者进行治疗,取得了比较满意的疗效,可以有效降低复发率,减少不良反应,显著改善临床症状,可在临床上推广应用.     

非动脉炎性视网膜中央动脉阻塞伴同侧颈内动脉闭塞患者的眼底影像特征

目的 探讨非动脉炎性视网膜中央动脉阻塞(NA-CRAO)伴同侧颈动脉闭塞患者的眼底影像特征。方法 回顾性研究。选择2019年11月至2021年11月在西安市人民医院(西安市第四医院)眼科住院治疗的NA-CRAO伴同侧颈内动脉闭塞患者32例32眼为颈内动脉闭塞组,选择同期住院治疗的NA-CRAO不伴有颈内动脉闭塞患者32例32眼为对照组。采用国际标准视力表检测患者最佳矫正视力(BCVA);对患者行瞳孔、眼球运动、裂隙灯显微镜、眼底彩色照相、OCT、荧光素眼底血管造影(FFA)、颈部血管超声多普勒、颅脑磁共振(MRI)、磁共振血管成像(MRA)检查。比较两组患者的臂-视网膜循环时间(A-Rct)、主干-末梢荧光素充盈时间(FT)、FFA特征、BCVA、眼底彩色照相、虹膜新生血管以及黄斑OCT特征。结果 颈内动脉闭塞组和对照组患者年龄、性别、眼别、发病时间以及高血压、糖尿病、高脂血症、高同型半胱氨酸血症患病率差异均无统计学意义(均为P>0.05);颈内动脉闭塞组患者A-Rct和FT较对照组均显著延长,差异均有统计学意义(P=0.016、0.003);颈内动脉闭塞组与对照组患者BCVA差...     

Oral fluorescein angiography: reassessment of its relative safety and evaluation of optimum conditions with use of capsules.

Injection of fluorescein intravenously for fundal angiography is associated with a high incidence of minor adverse effects (21%) but a very low incidence of serious (life threatening) reactions (0.05%). A serious reaction may occur without warning in a patient with no history of atopy. There are no reports of oral fluorescein causing a serious reaction, and minor adverse effects are uncommon. A study was undertaken to determine optimum conditions for oral fluorescein angiography. Capsules proved more convenient than a solution for ingestion of fluorescein. A dose of 25 mg/kg body weight produced good quality angiograms in 75% of the patients. The best pictures were obtained by photographing the fundus after 40 and 60 minutes.