[optimal] Re: Question on fluorescein dosages

From: Ray Gardner <raygardner99@xxxxxxxxx>
To: optimal@xxxxxxxxxxxxx
Date: Mon, 7 Feb 2011 14:52:42 -0800 (PST)

It really depends on what camera you are using and its capabilities. With single frame digital cameras you would need to use separate injections and changing the settings of the camera and requires a full 25mg dose of ICG. If you are using the Spectralis you can mix the dyes or do them separate. Most of the time, we mix the dyes together. If a clear feeder vessel is present I’ll take a single image of ICG by itself or select an image/s of the transit movie. There are times when I performed a fluorescein angiogram and the need for ICG is called for. I'll draw up 1cc of mixed ICG ( 5ccs of aquis in one bottle) in a separate syringe and mix it with 3-4cc of sterile water to give me a little more volume. I only change out the syringes without have to stick the patient twice. In the past assisting with feeder vessel lasers, I would insert a PDT angio-cath so that I could perform the first dye study. Then send them for laser. After the laser was complete, they would come back and have a second study done to check for good closer of the feeder vessel. This allowed us to only stick the patient once and do multiple tests. I used heparin-flush in-between injections to prevent clotting. It is known that if performing the dye studies separate you will get a little hire resolution and clarity. This is also due to the slight adjustment of dept, bringing the choroid into focus and not the retinal vessels.

G. Ray Gardner, CRA, OCT-C, COA, OSA

Southwest Retina Specialists

7411 Wallace Blvd.

Amarillo, Texas 79106

office (806)351-1870

fax (806)351-1690

cell (806)676-9793

email: raygardner99@xxxxxxxxx

From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
To: optimal@xxxxxxxxxxxxx
Sent: Mon, February 7, 2011 1:58:03 PM
Subject: [optimal] Re: Question on fluorescein dosages

So Ethan, you are using some type of stopcock for separate injections? Why would that be an advantage, if the FA arrives first, does it really make that much difference to have a bolus for the ICG?

Inquiring minds wish to know….

Denice Barsness, CRA, COMT, ROUB, FOPS

Ophthalmic Diagnostic Center

CPMC Department of Ophthalmology

2100 Webster Street Suite 212

(415) 600-3937 FAX (415) 600-6563

From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Ethan Priel
Sent: Saturday, February 05, 2011 5:20 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: Question on fluorescein dosages

Denice-

There are indeed different dosages for different purposes of ICGA.

For example, for locating feeder vessels one can use a fraction of the 25mg in the vial, since often times 2-3 angiographies are in order for the morning, and with the small amount the background fluorescence fades by the time the second angiography is needed.

For choroidal inflammatory diseases we need more of the late-stage photos, so larger doses are used.

In general we use the whole vial in most cases.

Regarding the simultaneous bolus vs. separate, here too the nature of the study dictates the mode of injection.

Unless the pathology indicates that simultaneous angiography would be beneficial, I employ the separate method, and perform simultaneous frames during the study.

Fluorescein precedes ICG injection by 2-3 minutes, which is very efficient, and there are many benefits to injecting Fluorescein first.

All the best,

Ethan

From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of CPMC Ophthalmic Diagnostic Center
Sent: 04 February, 2011 18:19
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Question on fluorescein dosages

Dear Optimal Tribe

Am looking for publication, survey, etc on the merits of Simultaneous FA/ICG cocktail

Interesting citations going back to 1999-2001 about correct dosages. I see one here out of Argentinausing 500mg CA and 12.5 mg of ICG in bolus. Can that be right?

We’re using 2 cc’s 25% FA ( 250mg/ml) and 4.5 cc reconstituted ICG in same syringe. Works great.

Retina docs telling me we must go back to old school of separate bolus, stopcock, separate syringes. Wouldn’t that defeat the purpose of SIMULTAENOUS FA/ICG?

Citation in “Ophthalmic Photography” Saine, Tyler “for simultaneous FA/ICG dosages of the two dyes are combined in the same syringe”. Exact dosages not mentioned.

I’d sure like to have a stronger argument than empirical evidence visa vis great photos on the Spectralis to make my case.

Thanks

Denice