Fatal acute myocardial infarction after intravenous fluorescein angiography

A light in the darkness: sodium fluorescein-assisted peripheral nerve sheath tumors resection - a comprehensive systematic review and single-arm meta-analysis

The treatment for peripheral nerve sheath tumors (PNSTs) is based on surgical excision and the primary goal is to improve symptoms whilst preserving neurological function. In order to improve this technique, surgeons may use sodium fluorescein (SF) to help visualize the neoplasm and, consequently, facilitate its removal. Aiming to assess the efficacy of this emerging surgical strategy, we conducted a systematic review and single-arm meta-analysis. We conducted a systematic search on the PubMed, Embase, and Web of Science databases, following the PRISMA guidelines. Studies without outcomes of interest, case series with less than four patients, letters, comments, technical notes, editorials, reviews, and basic research papers were excluded. The outcomes considered for this study were: the number of tumors that achieved total resection, subtotal resection, or near total resection, the approach/technique utilized by the surgeon, SF-related complications, and total complications. Five studies, with a total of 175 individuals, were included in our survey. Notably, 70% of the neoplasms presented by the patients were schwannomas. Considering extracranial lesions, we found a proportion of 96% (95% CI: 88 - 100%) in total resection, 0% (95% CI: 0-1%) in near total resection, and 4% (95% CI: 0-12%) in subtotal resection, all linked to an amount of 185 analyzed PNSTs. Furthermore, a proportion of 1% (95% CI: 0 - 2%) in SF-related complications was spotted among 183 patients. Finally, total complications analysis accounted for 11% (95% CI: 0 - 25%) among 183 individuals. We concluded that SF-assisted resection of PNSTs is a suitable and relatively safe technique, linked to minimum complications, of which the majority was not associated with the chemical compound itself. Future research is necessary to increase the number of patients available in the current literature and, therefore, enhance future analyses.

Chronic renal failure as predictive factor for acute elevation of systolic blood pressure after fluorescein angiography in patients with retinal diseases

Purpose

To investigate the influence of fluorescein angiography (FA) on blood pressure (BP) in patients with retinal diseases, and analyze the predictive factors for acute elevation of systolic BP after FA.

Design

and Methods: A prospective study was conducted with 636 patients undergoing FA between April 2021 and October 2021. BP and pulse were measured in each patient before and 20 min after FA. The baseline characteristics of patients who developed an acute elevation in systolic BP (>10 mmHg) were compared with those of the remaining patients to detect factors that may predict this acute elevation.

Results

Overall, mean systolic BP changed from 142 ± 17 mmHg to 140 ± 20 mmHg after 20 min (p = 0.1). Mean diastolic BP changed from 79 ± 15 mmHg to 78 ± 13 mmHg after 20 min (p = 0.45). Mean pulse rate changed from 73 ± 14 bpm to 70 ± 12 bpm after 20 min (p = 0.001). 103 patients (16 %) had acute elevation of systolic BP (>10 mmHg). Mean systolic BP changed from 143 ± 17 mmHg to 162 ± 19 mmHg after 20 min in this group (p = 0.001). Patients in this group were significantly older compared to the rest (73 ± 12 vs 67 ± 15, p = 0.001). The rate of chronic renal failure was significantly higher in this group compared to the rest of the patients (42/7.8 % vs 15/14.6 %, p = 0.01).

Conclusions

This study demonstrated that fluorescein angiography is a relatively safe procedure with regards to blood pressure changes. However, chronic renal failure could be considered as predictive factor for acute elevation of systolic blood pressure after this procedure.

Recent Advances and Perspectives in Relation to the Metabolomics-Based Study of Diabetic Retinopathy

Diabetic retinopathy (DR), a prevalent microvascular complication of diabetes, is a major cause of acquired blindness in adults. Currently, a clinical diagnosis of DR primarily relies on fundus fluorescein angiography, with a limited availability of effective biomarkers. Metabolomics, a discipline dedicated to scrutinizing the response of various metabolites within living organisms, has shown noteworthy advancements in uncovering metabolic disorders and identifying key metabolites associated with DR in recent years. Consequently, this review aims to present the latest advancements in metabolomics techniques and comprehensively discuss the principal metabolic outcomes derived from analyzing blood, vitreous humor, aqueous humor, urine, and fecal samples.

The Fluorescent Patient: An Unusual Effect of Fluorescein Angiography

Although fluorescein is widely used for intraoperative angiography, some of its side effects remain obscure. In this report, we present the case of a 41-year-old patient with chronic ischemia caused by moyamoya syndrome who underwent bypass revascularization with intraoperative fluorescein angiography (FA). Immediately after the surgery, the patient presented homogeneous fluorescence of the entire skin. We discuss this curious phenomenon as well as other side effects that may arise due to FA.

Effectiveness of MB-102, a novel fluorescent tracer agent, for conducting ocular angiography in dogs

OBJECTIVE

To evaluate the effectiveness of a novel fluorescence tracer agent, MB-102, for conducting ocular angiography in dogs.

ANIMALS

10 ophthalmologically normal dogs (2 to 4 years old) and 10 dogs with retinal degeneration or primary open-angle glaucoma (< 6 years old).

PROCEDURES

While anesthetized, all dogs received sodium fluorescein (20 mg/kg, IV) or MB-102 (20 or 40 mg/kg, IV) first and then the other dye in a second treatment session 2 days later in a randomized crossover design. Anterior fluorescence angiography was performed on one eye and posterior fluorescence angiography on the other. Imaging was performed with a full-spectrum camera and camera adaptor system. Filter sets that were tailored to match the excitation and emission characteristics of each angiographic fluorescent agent were used.

RESULTS

All phases and phase intervals during anterior and posterior segment angiography were identified, regardless of the dye used. However, agent fluorescence and visualization of the iridal blood vessels were hindered in some dogs, irrespective of agent, owing to the degree of iridal pigmentation present. No significant difference was noted between the 2 dyes in any phase or phase interval, and slight improvement in image contrast was observed with MB-102 during the venous phases owing to a reduction of vessel wall staining in both normal and diseased eyes.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that MB-102 would be useful for conducting ocular angiography in dogs.

Intravenous fluorescein angiography-associated adverse reactions

OBJECTIVES

To assess (i) the adverse reactions (ARs) associated with intravenous fluorescein angiography (IVFA); (ii) the relationship between a known history of IVFA-associated AR and ARs on the subsequent IVFA test; and (iii) the dose-response relationship between intravenous sodium fluorescein (NaFl) injection and ARs associated with IVFA.

DESIGN

Retrospective chart review.

PARTICIPANTS

A total of 2247 patients with 3381 consecutive IVFAs between May 2013 and April 2014.

METHODS

Fisher's exact tests or χ² tests were used to compare the percentage difference of IVFA-associated ARs for different categorical variables. Logistic regressions were used to assess the relationship between a known history of IVFA-associated AR and any AR(s) on a subsequent IVFA test.

RESULTS

The overall percentage for IVFA-associated ARs was 3.3%. Adjusted for age and sex, patients who had a previous IVFA-associated AR(s) were 6.2 times more likely (adjusted odds ratio 95% CI 3.4-11.2, p < 0.0001) to have an AR compared to those who did not. Among 17 patients who had 2 repeated IVFA tests and an AR on the first IVFA test, the rate of AR on the second test was lower in patients who received a reduced dosage of NaFl (n = 14) compared to those with the standard dosage (n = 3) (35.7% vs 66.7%); however, this finding was not statistically significant (p = 0.5368).

CONCLUSIONS

The rate of IVFA-associated ARs in this study was low. Patients who had a known IVFA-associated AR were more likely to re-experience an AR on a subsequent test compared to those who did not. In addition, a reduced NaFl dose did not significantly reduce the chance of experiencing an AR on a subsequent test, which is likely because of the insufficient power of this comparison.

Comparison of adaptive optics scanning light ophthalmoscopic fluorescein angiography and offset pinhole imaging

Recent advances to the adaptive optics scanning light ophthalmoscope (AOSLO) have enabled finer in vivo assessment of the human retinal microvasculature. AOSLO confocal reflectance imaging has been coupled with oral fluorescein angiography (FA), enabling simultaneous acquisition of structural and perfusion images. AOSLO offset pinhole (OP) imaging combined with motion contrast post-processing techniques, are able to create a similar set of structural and perfusion images without the use of exogenous contrast agent. In this study, we evaluate the similarities and differences of the structural and perfusion images obtained by either method, in healthy control subjects and in patients with retinal vasculopathy including hypertensive retinopathy, diabetic retinopathy, and retinal vein occlusion. Our results show that AOSLO OP motion contrast provides perfusion maps comparable to those obtained with AOSLO FA, while AOSLO OP reflectance images provide additional information such as vessel wall fine structure not as readily visible in AOSLO confocal reflectance images. AOSLO OP offers a non-invasive alternative to AOSLO FA without the need for any exogenous contrast agent.

Safety of sodium fluorescein for in vivo study of skin

BACKGROUND/PURPOSE

Epicutaneous labeling or intradermal injection of the fluorescent sodium fluorescein is being used increasingly to investigate skin conditions in vivo when using non-invasive devices such as confocal scanning laser microscopy. Sodium fluorescein was used intravenously for decades for the examination of the vasculature of the ocular fundus (fluorescein angiography) and as eye drops for diagnosis of corneal erosions. The objective of this article is to systematically review the literature on fluorescein and conclude its safety in cutaneous research to support research planning and evaluations by ethics committees.

METHODS

A number of databases and the literature about safety and toxicity of fluorescein in animal and human studies were searched and analyzed.

RESULTS

Side effects or adverse events reported in the literature were related to intravenous bolus injection. Transient nausea and vomiting may occur. Other adverse events such as vasovagal reaction, cardiac or respiratory effects and anaphylaxes are extremely rare but may be fatal. Intradermal injection may cause mild itch or pain; systemic adverse event was reported. Epicutaneous labeling is associated with no reported problem. A typical local dose is several magnitudes of order smaller than a typical intravenous dose.

CONCLUSION

Fluorescein has been used for many years in medicine for diagnostic purposes and is widely safe, albeit intravenous bolus injection may cause serious adverse reactions. In the literature, we could not trace reports of local or systemic side effects of topical sodium fluorescein except itch and pain on intradermal injection, however, dependent on the fluorescein preparation used. Local dermal application of fluorescein for in vivo study of skin may be considered widely safe.

Fluorescein angiographic monitoring of corneal vascularization in lipid keratopathy

The use of digital fluorescein corneal angiography to assist argon laser photocoagulation is reported. Photocoagulation was performed on the vascular supply of lipid keratopathy in the left eye of a 44-year-old woman.

UNUSUAL REACTION TO FLUORESCEIN DYE IN PATIENTS WITH INFLAMMATORY EYE DISEASE

PURPOSE

Ocular side effects attributable to intravenous fluorescein dye are not well characterized. The purpose of this report was to describe three patients with an unusual ocular reaction after the intravenous administration of fluorescein dye.

METHODS

Retrospective review of the clinical and photographic records of three patients.

RESULTS

Each patient had some type of preexisting ocular inflammatory disease. Each patient described the subacute onset of a unilateral burning sensation and tearing several minutes after the administration of intravenous fluorescein dye. Findings included a new onset of or a worsening of unilateral conjunctival chemosis and injection in all three patients and yellowish discoloration of the conjunctiva in two patients. In each patient, the noninflamed (fellow) eye did not develop any symptoms or show any visible reaction. The symptoms and findings resolved promptly in the affected eye without specific treatment or effect on vision.

CONCLUSIONS

Ocular side effects of intravenous fluorescein dye can include transient symptomatic burning and tearing associated with conjunctival chemosis, injection, and yellowish discoloration. Eyes with active inflammatory diseases may be predisposed to this rare effect through an unclear mechanism.

Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programme

AIMS

To assess if oral fluorescein angiography (OFA) is a suitable screening method to detect macular oedema in diabetic retinopathy.

METHODS

Eighty-four diabetic patients were included in the study. They were from a consecutive series of patients attending the diabetic eye-screening clinic, with retinopathy at the macula requiring ophthalmology assessment. All patients were subsequently examined in the eye hospital, by ophthalmologist slit lamp biomicroscopy assessment as the gold standard, followed by oral fluorescein angiography.

RESULTS

This study indicates a sensitivity of 92% and specificity of 81%. Only 4.8% of patients developed a minor reaction to oral fluorescein; 84.5% of images were of good quality.

CONCLUSIONS

Oral fluorescein angiography is an efficient and highly sensitive tool for the detection of macular oedema. It can be used as an adjunct in the diabetic screening service to identify patients with oedema within a disc diameter of the macula. Ultimately it will ensure that only necessary and smaller numbers of patients are referred to ophthalmologists.

Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review

PURPOSE

To evaluate the occurrence of cystoid macular edema (CME) after lens extraction, anterior vitrectomy, and intraocular lens implantation (IOL) in children using angioscopy after administration of oral fluorescein.

SETTING

Centers in Tamil Nadu, India, and Hong Kong, China.

METHODS

This study comprised 18 children (28 eyes) who had cataract extraction, posterior capsulorhexis, anterior vitrectomy, and in-the-bag IOL implantation. The presence of CME was evaluated 1 week and 4 to 6 weeks after surgery using fluorescein angioscopy.

RESULTS

Anterior chamber fibrin occurred in 4 eyes (14.3%). Fluorescein angioscopy was performed 1 week after surgery in all eyes and after 1 month in 25 eyes (89.3%). No eye demonstrated the presence of CME on fluorescein angioscopy.

CONCLUSIONS

Cystoid macular edema did not occur in the early period after pediatric cataract surgery using current surgical techniques. Longer follow-up is required to ascertain the incidence of CME in the late postoperative period.

Efficacy and safety of fluorescein angiography with orally administered sodium fluorescein

PURPOSE

To report the efficacy and safety of fluorescein angiography after oral administration of fluorescein solution in a large number of patients during a period of 8 years.

METHODS

A total of 1,787 patients (2,625 eyes) underwent fluorescein angiography after oral administration of sodium fluorescein at Hara Eye Hospital, Utsunomiya, Japan, between January 1989 and March 1997. The ingestible solution was 10 ml of 10% sodium fluorescein, the same material generally used for injection in conventional fluorescein angiography. Retinal photography began 15 minutes after ingestion and continued for 1 hour. The camera and the photography and film processing techniques were the same as those used for conventional fluorescein angiography using injected sodium fluorescein.

RESULTS

In 2,554 (97.3%) of 2,625 eyes, photographs adequate for clinical use were obtained. In 1,787 patients, no anaphylactic or other severe adverse effects were observed, and only 31 patients (1.7%) experienced minimal itching, discomfort, or nausea after oral sodium fluorescein intake. For conditions such as central serous chorioretinopathy, retinal vein occlusion, diabetic retinopathy, and cystoid macular edema, sufficient information for clinical use was obtained.

CONCLUSIONS

Fluorescein angiography using orally administered sodium fluorescein is generally effective and safe in standard clinical practice.