Fluorescein mfg is relatively simple still costs pennies per vial to make,
you can feel comfortable blaming the manufacturer for any bad batches
On Jun 4, 2016 5:48 AM, "Angela Chappell" <angela.chappell@xxxxxxxxxxxxxxx>
wrote:
Hi Jim
Good to hear from you and glad that Anton and Paula remembered my FA/back
pain article from years ago (perhaps Paula more clearly) and that Tim could
pull it up to read.
As you might have already read, the back pain symptoms these patients
(from around the whole country) experienced during FA were attributed to a
batch of fluorescein which likely contained a higher level of impurity than
it should have. My take on it is that the chemical processes involved in
producing sodium fluorescein are complex and exacting and there is scope
for residual chemical impurity which may not be detected by standard
product testing procedures.
It would be interesting also to understand the clinical mechanism with the
back pain - eg. whether it is actually kidney pain. I see the article
Darrin mentioned on back pain with verteporfin suggests it was caused by
"circulating thromboxanes" (whatever they are).
Apparently back pain has also been reported with patients having Heparin
infusion.
Anyway I think you should keep an ear out in case there are any more back
pain incidents, which could indicate a more widespread problem.
Kind regards, Angela
Sent from my iPad
patient whom I performed an FA and ICG combined study on this afternoon,
From: Jim Soque <jsoque@xxxxxxxxxxx>
Subject: [optimal] FA/ICG Observation.
Date: Wed, 1 Jun 2016 15:30:19 -0400
Optimalers,
I had an interesting scenario that played out for a long standing
June 1, 2016.
This patient with a history of dry ARMD, and 10 year history with ouroffice, has a PMH of Renal Artery Stenosis, and hypertension.
The ICG test was performed first, and was photographed through the earlyphases. Then, the FA portion of the test was performed, and was
photographed to only 70 seconds. The patient abruptly removed her head and
cried out, 'I have a back spasm' followed by rapid breathing, grasping for
her lower back with a free hand, and bringing the test to a stand still for
approx. 7-8 mins.
The episode ended without incident, the patient recovered, I was allowedto finish the FA/ICG test, and we walked to the examination room together.
We are just curious to see if FA or ICG dye had ever produced activitysuch as this in your office before.
Thank you in advance.
Jim Soque
Island-Retina.com
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