Fluorescein angiography of the eye

Place of FA in the ophthalmological examination structure

In clinical practice, an ophthalmologist follows a clear examination algorithm. Fluorescein angiography is not part of basic screening, but is used to verify a suspected diagnosis.

The primary standard diagnostic scope includes:

• Determination of visual acuity (visometry).
• Measurement of intraocular pressure level (ophthalmotonometry).
• Biomicroscopy of the anterior segment structures of the eye.
• Examination of the ocular fundus (ophthalmoscopy).

If standard methods are insufficient, additional studies are prescribed to clarify the clinical picture. These include optical coherence tomography (OCT) of the optic nerve and retina, computer perimetry, ultrasound of the eyeball, color Doppler ultrasound of vessels, and fluorescein angiography directly.

Equipment and clinical significance of angiography

To perform the procedure, monitor contrast distribution, and accurately record fluorescence, a specialized device is used — the fundus camera. Modern devices, among which non-mydriatic models are actively used, make it possible to take a series of high-quality fundus photographs in a very short time.

In clinical practice, FA is a crucial tool for differential diagnosis. The main significance of the method lies in detecting hidden pathologies of:

• The inner coat of the eye (retina).
• The middle coat of the eye (uveal tract).
• The optic nerve.

Special attention is paid to assessing retinal blood flow when proliferative retinopathy is suspected. If this diagnosis is confirmed, the patient is strictly referred for treatment to a specialized ophthalmological center. The diagnostic minimum for retinopathy includes a specialist consultation, examination with a wide pupil (using a slit lamp and a wide-field indirect ophthalmoscope), and mandatory FA.

Specifics of managing patients with sickle cell disease

Ophthalmological complications frequently accompany systemic blood disorders. All patients with sickle cell disease (SCD), starting from a very early age, are in the target risk group. They are indicated for an annual extended ophthalmological examination aimed at the timely detection of specific changes.

The scope of routine screening in SCD includes:

1. Tonometry (control of intraocular pressure).
2. Ophthalmoscopy.
3. Fluorescein angiography (performed as needed).

Important clinical note: Eye trauma or trauma to the entire periorbital region in a patient with SCD is an absolute urgent situation requiring immediate medical intervention. In such cases, there is an extremely high probability of developing hyphema (massive hemorrhage into the anterior chamber of the eye). This condition triggers a sharp increase in intraocular pressure, which can lead to irreversible vision loss.

Examination algorithm and pediatric specifics

Any ophthalmological examination is performed according to a strict protocol. The doctor consistently collects biographical data, main complaints, medical and life history. Next, the general condition of all body systems is assessed (Status praesens). The local ophthalmological status (Status localis) is recorded in maximum detail, in a clear anatomical sequence, and obligatorily for each eye separately.

Examining young children presents a particular challenge due to frequently occurring blepharospasm. For full diagnostics, a special rigid fixation technique is used:

• The child is placed supine on the nurse's lap.
• The patient's head is firmly clamped between the doctor's knees.
• The nurse presses the child's legs to herself with one hand, and pulls and securely fixes their arms with the other.

To evert the eyelids in infants, the doctor gently presses on them, pulls and shifts them towards each other. To fully open the eyelids and examine the anterior segment of the eye, special instruments are used — eyelid speculums. Examination of the deep parts of the fundus in children is most effective when using an electric ophthalmoscope.

Class and exam questions

What else to study on this topic

• Methodology of anterior segment biomicroscopy
• Optical coherence tomography (OCT) of the retina and optic nerve
• Pathogenesis of hyphema formation and its complications
• Operating principles of the indirect wide-field ophthalmoscope
• Strict anatomical sequence of Status localis description

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.