Bindewald A, Stuhrmann O, Roth F, Schmitz-Valckenberg S, Helb H-M, Wegener A, Eter N, Holz F G
Department of Ophthalmology, University of Bonn, Ernst-Abbe-Strasse 2, D-53127 Bonn, Germany.
Br J Ophthalmol. 2005 Dec;89(12):1609-15. doi: 10.1136/bjo.2005.070409.
With the advent of digital confocal scanning laser ophthalmoscopy it is possible to detect low levels of fluorescence. Here we used a novel confocal scanning laser ophthalmoscope (cSLO) to determine lower limits of dye required for fluorescein (FL) and indocyanine green (ICG) angiography.
A cSLO (Heidelberg retina angiograph 2, Heidelberg Engineering, Dossenheim, Germany) with an optically pumped solid state laser (488 nm) for FL and a diode laser (790 nm) for ICG angiography (FL/ICG-A) was used. 62 FL-As were performed in 53 patients and 45 ICG-As were performed in 39 patients with neovascular age related macular degeneration. The volume and overall dye content of bolus injections was gradually tapered (FL: 500 mg, 250 mg, 200 mg, 166 mg, 100 mg; ICG: 25 mg, 20 mg, 15 mg, 10 mg, 5 mg, 2.5 mg), while dye concentrations were kept constant at 100 mg/ml for FL and at 5 mg/ml for ICG. Images were obtained 1, 5, 15, and 30 minutes after dye injection. Image quality was evaluated by two independent readers using standardised criteria.
For amounts down to 166 mg for FL and to 5 mg for ICG, sufficient image quality was achieved during all phases following injection. Only late phase images showed less contrast compared to typically used dye amounts, which was irrelevant for interpretation and clinical management.
With the increased sensitivity of this novel cSLO system, amounts of injected dye during FL-A can be reduced to one third for FL and to one fifth for ICG without relevant loss of image quality or information compared to conventionally used dye levels. These amounts can be used for routine angiography and allow relevant savings for units performing FL-A.
随着数字共焦扫描激光眼科检眼镜的出现，检测低水平荧光成为可能。在此，我们使用一种新型共焦扫描激光眼科检眼镜（cSLO）来确定荧光素（FL）和吲哚菁绿（ICG）血管造影所需染料的下限。
使用一台cSLO（德国海德堡工程公司位于多森海姆的海德堡视网膜血管造影仪2），其配备用于FL血管造影的光泵浦固态激光器（488 nm）和用于ICG血管造影（FL/ICG-A）的二极管激光器（790 nm）。对53例患者进行了62次FL血管造影，对39例新生血管性年龄相关性黄斑变性患者进行了45次ICG血管造影。团注注射的体积和总染料含量逐渐减少（FL：500 mg、250 mg、200 mg、166 mg、100 mg；ICG：25 mg、20 mg、15 mg、10 mg、5 mg、2.5 mg），同时FL的染料浓度保持在100 mg/ml恒定，ICG的染料浓度保持在5 mg/ml恒定。在染料注射后1、5、15和30分钟获取图像。由两名独立的阅片者使用标准化标准评估图像质量。
对于FL低至166 mg以及ICG低至5 mg的剂量，注射后所有阶段均获得了足够的图像质量。与通常使用的染料剂量相比，仅晚期图像的对比度较低，但这对解读和临床管理无关紧要。
随着这种新型cSLO系统灵敏度的提高，与传统使用的染料水平相比，FL血管造影期间FL的注射染料量可减少至三分之一，ICG的注射染料量可减少至五分之一，而图像质量或信息无相关损失。这些剂量可用于常规血管造影，并可为进行FL血管造影的单位节省相关费用。
