Kwan Anthony S L, Barry Chris, McAllister Ian L, Constable Ian
Lions Eye Institute, 2 Verdun Street, Nedlands, WA 6009, Australia.
Clin Exp Ophthalmol. 2006 Jan-Feb;34(1):33-8. doi: 10.1111/j.1442-9071.2006.01136.x.
The last major survey of adverse reactions to intravenous fluorescein angiography was performed more than 20 years ago. There have been two recent fatalities involving intravenous fluorescein in Australia. It is important to review the current incidence of adverse reactions and latest literature on the pathogenesis, prophylaxis and alternatives to intravenous fluorescein angiography.
A retrospective review of all adverse reactions to intravenous sodium fluorescein in patients undergoing fluorescein angiography between June 1998 and June 2004 was undertaken. The total number of fluorescein angiograms performed and the number of patients with adverse reactions were identified from the photographic department database and the fluorescein adverse reaction register at the Lions Eye Institute.
A total of 11 898 fluorescein angiograms were performed during the study period. There were 132 adverse reactions recorded. The commonest adverse reactions were nausea and vomiting. There were no serious adverse reactions or deaths recorded. There was a statistically significant difference in the incidence of adverse reactions between sodium fluorescein used from two manufacturers.
Fluorescein angiography is a relative safe procedure and comparable to other intravenous radiocontrast media angiography or investigation. The present results are consistent with previous studies. Prophylactic treatment, fluorescein desensitization or oral fluorescein angiography should be considered in high-risk patients. Safe guards should be in place to manage potential serious adverse reactions. Other imaging techniques, like optical coherence tomography, should be considered as an alternative in selected cases.
上一次关于静脉注射荧光素血管造影不良反应的重大调查是在20多年前进行的。澳大利亚最近有两起涉及静脉注射荧光素的死亡事件。回顾当前不良反应的发生率以及关于静脉注射荧光素血管造影发病机制、预防措施和替代方法的最新文献非常重要。
对1998年6月至2004年6月期间接受荧光素血管造影的患者中所有静脉注射荧光素钠的不良反应进行回顾性研究。从摄影部门数据库和狮子眼研究所的荧光素不良反应登记册中确定进行的荧光素血管造影总数和出现不良反应的患者数量。
在研究期间共进行了11898次荧光素血管造影。记录到132例不良反应。最常见的不良反应是恶心和呕吐。未记录到严重不良反应或死亡事件。来自两家制造商的荧光素钠在不良反应发生率上存在统计学显著差异。
荧光素血管造影是一种相对安全的检查方法，与其他静脉注射放射性造影剂血管造影或检查相当。目前的结果与先前的研究一致。对于高危患者，应考虑预防性治疗、荧光素脱敏或口服荧光素血管造影。应制定安全保障措施来处理潜在的严重不良反应。在某些特定情况下，应考虑其他成像技术，如光学相干断层扫描，作为替代方法。
