Thirty some years ago I used 25% NaFl for a while. I couldn't see any big
difference in the intensity of the fluorescence (Paul Montague had a good
article about "fluorescence quenching" with higher concentrations). I did come
across a few vials months later that I decided to use up. I noticed that there
were large crystals in the vials, just from sitting in the cabinet (if the dye
is stored in a refrigerator it is more likely to happen). I have a photograph
of the crystals somewhere in my archives.
I shook up the vials before use to redissolve the crystals. No back pain
problems with those patients.
But I would suggest checking for crystals before using 25%. Have never seen it
with 10%.
Tom
________________________________
From: optimal-bounce@xxxxxxxxxxxxx <optimal-bounce@xxxxxxxxxxxxx> on behalf of
stu weedn <stuweedn@xxxxxxxxx>
Sent: Saturday, June 4, 2016 12:48 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: FA/ICG Observation
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<mailto: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
From: Jim Soque <jsoque@xxxxxxxxxxx<mailto: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 patient
whom I performed an FA and ICG combined study on this afternoon, June 1, 2016.
This patient with a history of dry ARMD, and 10 year history with our office,
has a PMH of Renal Artery Stenosis, and hypertension.
The ICG test was performed first, and was photographed through the early
phases. 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 allowed to
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 activity such
as this in your office before.
Thank you in advance.
Jim Soque
Island-Retina.com
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