Denice good morning. The term simultaneous angiography does not NECESSARILY mean that the dyes are injected at the same time. It means, mostly, that since both dyes are 'in the system', it is therefore possible to image the retina and the choroid at the same time, employing both dedicated wavelengths (FA +ICG) and get both images 'side by side'. The benefits include the ability to compare locations of pathology accurately while bringing up the images side by side. Ethan From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of CPMC Ophthalmic Diagnostic Center Sent: 08 February, 2011 01:04 To: optimal@xxxxxxxxxxxxx Subject: [optimal] Re: Question on fluorescein dosages I guess I’m not framing my question well If the concept is “SIMULTANEOUS FA/ICG” then wouldn’t the injection have to be simultaneous as well? 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: Tuesday, February 08, 2011 12:37 PM To: optimal@xxxxxxxxxxxxx Subject: [optimal] Re: Question on fluorescein dosages Denice hi, Don’t use a stopcock. Inject Fluorescein Flush w/saline Leave saline syringe connected Wait 3 mins, do the serious Fluorescein angiography work Connect ICG syringe Inject Flush w / saline Leave syringe connected with open vein for 3-5-8 mins, depending on patient Disconnect tubing, patch with a bit of pressure. Bob, uncles, etc. Now, I don’t really get your query. Why Fluorescein first ? many advantages, you want the list >>?>???? Is it beneficial to have a separate, full =resolution for each transite phase/??? Ethan From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of CPMC Ophthalmic Diagnostic Center Sent: 07 February, 2011 21:58 To: optimal@xxxxxxxxxxxxx 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 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
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