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A case series on the use of oral fluorescein angiography for pre-cataract workup with an ultra-wide field scanning laser ophthalmoscope

Poster Details

First Author: N.Lemanski USA

Co Author(s):    B. Lemanski   M. Cheng                 

Abstract Details

Purpose:

Visualization of retinal vasculature in high risk patients prior to cataract surgery is critical to reducing complications during the post-operative period. To this end, injection fluorescein angiography is considered the current gold standard to visualize retinal vasculature but potential for adverse side effects limits more widespread use in general practice. Previously, oral fluorescein angiography (OFA) has been examined as a potential alternative. However, poor image quality and late-phase only angiography were limiting factors. Current scanning laser ophthalmoscope technologies have the potential to increase the clinical usefulness of OFA.

Setting:

Mabel Cheng MD PLLC, Eye Physicians and Surgeons In office, 2 physician private practice.

Methods:

Retrospective analysis of 15 patients that received OFA in preparation for cataract surgery was conducted. Patients were 60-93 years old, weighing between 150-330 pounds. Exclusions: pregnancy, breast-feeding, PKU, soy allergy. Those with kidney disease were included as long as they had verbal consent from their primary physician. Patients were dilated with 1% tropicamide. After informed consent, weight and blood pressure, patients were given the option of liquid versus capsular formulation and subsequently imaged.

Results:

Time from ingestion to first observable fluorescein ranged from 2-14 minutes. Eighty five percent of the patients showed observable fluorescence at 8 min, with maximum fluorescence at 15-22 minutes. Choroidal flush was not observed in OFA. Early, mid, and late phases were observed in 90% of patients. Capsular formulation increased time in all phases. Patients weighing over 250 pounds, had anterior or posterior capsular plaques, or had 4 NS had decreased contrast on the angiogram. Defocused imaging techniques and post-processing can compensate for decreased fluorescence. There were no allergic reactions. Most common complaint was temporary dysgeusia.

Conclusions:

OFA is a simple and effective alternative to IVFA. Longer transit times allow for panning and defocusing photos to be obtained by a novice photographer. Costs are similar but OFA does not require a nurse or physician for administration. Elimination of needles, infectious waste and potential for injury, along with painless administration and low incidence of allergic reaction makes OFA appealing. This preliminary study demonstrates that OFA is a good in office diagnostic tool for high-risk patients prior to cataract surgery and may have potential to be used as a pre-surgical screening tool.

Financial Disclosure:

NONE

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