Dear Abul If that patient had a combined CRVO and CRAO it is likely in my opinion that you will still see dye as it enters the choroidal circulation in the early phase of the FA as the choroid is vascularized by two separate arterial systems, the short posterior ciliary arteries, which supply the posterior choroid and the long posterior ciliary arteries, which supply the anterior portion of the choroid and as these arteries are branches of the ophthalmic artery which is the first major branch of the internal carotid arteries I expect you will see some dye in the choroid unless the patient has some occlusion of the carotid artery. It would be interesting to hear other opinions on this . Stephen Travers Heidelberg Engineering From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of abul khair Sent: Tuesday, October 08, 2013 12:13 PM To: optimal@xxxxxxxxxxxxx Subject: [optimal] Re: No infiltration...no Fluorescein I had a little question about that, If the patient had (RA&VO) retinal artery & vain both occlusions then what?. Is it possible to see any dye in the retina?. It is my curiosity to know.Because I have had this type of patient few days ego,after pushing FA dye i did not see any dye in retina. Abul Khair senior ophthalmic photographer Dept.of ophthalmology BIRDEM hospital Dhaka 1000 Bangladesh. ________________________________ From: Hasan Omairah <shagroon@xxxxxxxxxxx<mailto:shagroon@xxxxxxxxxxx>> To: Optimal Freelist <optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>> Sent: Tuesday, October 8, 2013 10:49 PM Subject: [optimal] Re: No infiltration...no Fluorescein It happened to me twice so far. Both were females, diabetics, and had weight problem. We don’t use butterfly needles anymore –quite rarely I guess - instead a nurse inserts an angio-cath. On both cases the line was in place and there were no sign of leakage or extravasation. Both patients had fairly good media, with nicely dilated pupils, their cooperation and fixation was very good though, nevertheless No dye was visible during any stage, and I had to check the camera in-between phases just to make sure all are OK. I used a drop from what was left in the FA ampule, one a small piece of tissue, and another drop from Benoxinate/fluorescein on another piece of tissue, had it in-front of the camera and took few shots; still both fluoresce, therefore I knew the filter, barrier, camera and flash are fine, the culprit was something else! We have seen the patients on intervals of (1wk, 1month, 3months, and 1 year) post injection, and they didn’t complain of any pain, skin necrosis, or any other sign of extravasation, but strangely both experienced discoloration of their urine, and the discoloration lasted over one day, which I believe was consistent with the dye being pushed in ok. No skin discoloration on or near the injection site, no swelling, or anything that is abnormal! In our practice we use AK-Fluor - fluorescein injection 10% for so many years and we didn’t have any problem with its stability, and both of these cases were from two different batches. Still; normal FA’s were obtained from both batches on different patients. Nothing we can think of explained why no dye was visible. Hasan [http://arabeyez.info/imgs/Hasan_sig.png] ,-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-, , Hasan Omairah AAS COT OCT-C CRA , Department of Ophthalmology MBC (97) , King Faisal Specialist Hospital & Research Center , PO Box 3354 , Riyadh, 11211 , Saudi Arabia ,-------------- , Mobile-Pager within KFSH 44345 , +966 11-557-6131(work) , +966 11 442-4975 (fax) , -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-, "True wisdom comes to each of us when we realize how little we understand about life, ourselves, and the world around us" -Socrates ________________________________ Subject: [optimal] No infiltration...no Fluorescein Date: Tue, 8 Oct 2013 09:39:57 -0400 From: slusk@xxxxxxxxxxxxx<mailto:slusk@xxxxxxxxxxxxx> To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx> Has anyone ever experienced a phenomenon where an FA injection did not infiltrate, or at least we did not have any indication of infiltration, and no dye infuses into the retinal blood vessels? All camera functions we're verified and set correctly and the Color fundus and redfree images we're good. Just curious. Thanks Steve Lusk, CRA Vistar Eye Center Retina Consultants 5296 Peters Creek Road Roanoke, VA 24019 Phone: (540) 342-3400 ext. 4731 Fax: (540) 362-1155 slusk@xxxxxxxxxxxxx<mailto:slusk@xxxxxxxxxxxxx> www.vistareye.com<http://www.vistareye.com/> The information contained in this email may contain confidential health information that is privileged and legally protected from disclosure by federal law, the Health Insurance Portability and Accountability Act (HIPAA). This information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that reading, disseminating, disclosing, distributing, copying, acting upon or otherwise using the information contained in this facsimile is strictly prohibited. If you have received this information in error, please notify the sender immediately. Thank you.