1. Fluorescein fundus angiography (FFA) involves injecting a dye and using filters to examine blood flow and leakage in the retina and choroid over time. 2. Optical coherence tomography (OCT) uses infrared light to create cross-sectional images of the retina, examining layer integrity and thickness. 3. Both FFA and OCT provide important diagnostic information but require careful descriptive analysis and avoiding premature diagnosis.

1. Fluroscein Fundus Angiography FFA
Optical Coherence Tomography OCT
Samhaa Mohammed Abd Elmoneim
Zagazig Ophthalmic Hospital

2. FFA
Fluorescence
• Property of a substance to be stimulated by light of
short wave length to emit light of longer wavelength.

3. Fluorescence
• Blue excitation filter
• Yellow-green barrier filter

4. Fluorescein
** (a water-soluble dye) is injected IV remains intravascular 
85% bound to albumin & 15% free.
** The choriocapillaris are permeable to fluorescein molecules,
while retinal blood vessels & capillaries are not.
** Excretion through kidney

5. • Fluorescein (water soluble) -----15% free.
• Choriocapillaries ----- permeable.
• Large choroidal vs, Capillaries & Retinal vs
----- impermeable.

6. Permeable
• Choriocapillari
es
• Others: MA,
NV
Impermeable
• Retinal vs
• Large
choroidal vs
Impermeable
• Capillaries

7. Facilities
(reclining chair,
resuscitation
trolley & staff)
Contraindication
- Absolute (anaphylactic shock)
- Relative (renal failure, asthma,
pregnancy, cardiac dis.)
Explanation
(SE) & Formal
consent
Mydriasis
Media opacity !!!
- IV cannula
- Compfortable sitting
- Coloured , FAF photos
- Injection (5ml of 10%
Technique

8. Autofluorescence

9. Phases:
• Prearterial. (10-13 sec)
• Arterial. (12-15 sec after injection)
• Arterial Venous Transit Time (AVT)
• Venous (25-30 sec).
• Late (recirculation).

10. Choroidal flush Arterial phase

11. Av phase

12. Mid venous
phase
Late venous
phase

13. 4 3 5
6 2 1

14. Hyperfluorescence
Autofluorescene
(RPE, Drusen, early
Stargardt)
Pseudofluorescence
(Filters issues)
Hyperfluorescence
↑ Visualization of
normal fluorescein
(Transmission defect)
Window defect
(↑intensity)
eg: RPE atrophy
↑ in fluorescein
content
Leakage (↑intensity,
size, end ill defined)
eg: NV, CME, CNV
Pooling
(↑intensity ,size, ends
well defined)
eg: CSR, PED (not size)
Staining (dye
retension )
eg: normal OD, fibrous
tissue, drusen,
exposed sclera)

15. Hypofluorescence
Blockage (masking)
Masking retinal
fluorescence
eg: preretinal blood
Masking choroidal
fluorescence
Blood
eg: intrarenal /
subretinal hge,
Pigment
eg: choroidal
naevus, CHRPE
Inadequate
perfusion (filling
defect)
Vascular occlusion
eg: RVO, RAO,
capillary drop out
Loss of vascular bed
eg: choroidemia,
myopic degeneration

16. How to comment?
Investigation is an art of
description (donot jump to Dx)

17. 1. Filling timing (choroid, arteries, veins,
recirculation)
2. Hyper/ Hypo flurescence lesion
number
site
size(DD)
shape
edges
intensity
change of intensity.
3. Synchronicity
4. FAZ
5. Disc area

18. FAZ
• Normal: hypoflurescent, oval or round.
• Leakage: petalflower appearance, ink blot.
• Ischaemic : enlarged, irregular capillary budding
enhanced capillaries visualization

19. Hyperfluorescence early in
choroidal phase ↑ intensity
not size (window defect)
RPE atrophy
Hyper f starts well and ends ill
defined, ↑intensity , size
( leakage)
CNV

20. Hper f ↑size and
intensity in early phases
(pooling)
smoke stalk , ink plot in
CSR
Hyper f ↑intensity not size
(pooling) PED

21. Hyper f in late phase
(staining)
Scars of laser

22. Hper f ↑size , intensity
ends ill defined
CNV

23. Hyper f (flower petal
appearance),
↑size, intensity (leakage)

24. Hypof (filling defect)
BRAO
Hypo f (filling defect)
Capillary drop out
Ischaemic CRVO

26. 1. Filling timing (choroid, arteries, veins,
recirculation)
2. Hyper/ Hypo flurescence lesion
number
site
size(DD)
shape
edges
intensity
change of intensity.
3. Synchronicity
4. FAZ
5. Disc area

27. Conclusion
• Investigation is an art of description.
• FFA reflects tissue integrity.
• Donot jump to Dx, learn how to describe.
• Describe then you easily find Dx

28. OCT
• OCT (infrared light interferometry) is analogous of B
scan (sound waves)

29. OCT
Time
domain
Spectral
domain
Swept
source
Macular dis, retinoschesis
Post segment OCT
Glaucoma
NFL OCT
ACG, Corneal analysis
Anterior segment OCT

30. GCL, INL, ONL
Hyporeflective Layers
IPL, OPL, NFL
Hyperreflective Layers
RPE, OS/IS, ELM
Hypereflective Bands

31. OCT

32. OCT

33. OCT
linear 3D
Radial

34. OCT report
• Scan pattern (3D, radial, line).
• Vitreoretinal interface.
• Epiretinal membrane.
• Foveal contour.
• Arrangement of retinal layers (regular, irregular,
why?).
• Thickness.
• CME?
• Neurosensory detachment.
• RPE-choriocapillaris complex.
• Associated retinoschisis.
• Diagnosis.

35. OCT
CSR
RPE
atrophy

36. OCT
Drusen
CNV wet
AMD

37. OCT
PED
CME

38. OCT