[optimal] Re: optimal Digest V2 #20
- From: "Callahan, Charlene" <Charlene_Callahan@xxxxxxxxxxxxxxxx>
- To: <optimal@xxxxxxxxxxxxx>
- Date: Wed, 9 Feb 2011 09:57:44 -0500
A few years ago one of Dr Staurenghi's fellows helped us with combined
injections and "simultaneous" imaging. We have NOT used this cocktail technique
for about two years.
1. Dilute 25mg ICG dye with 3cc of the manufacturer's solvent.
2. Remove 1.5 cc 10% fluorescein dye from the 5cc vial. (I don't remember if we
saved this or discarded it)
3. Add 2cc ICG mix to the vial containing 3.5 cc fluorescein dye. Draw up the
entire vial into a syringe for the injection followed by a 5cc saline flush. We
usually used an in-welling catheter with a stopcock, but have also taped down a
butterfly and switched syringes.
Dosage will be 16.6 mg ICG and 70 mg Fluorescein.
For the SLO with FA/ICG setting, first expose for the FA then the ICG.
Our nurses would not use this method if the patient had not had both dyes
previously and without problems. As I've mentioned we no longer use this
procedure.
Hope this helps'
Charlene
Charlene DeLena Callahan
Ophthalmic Photographer
Massachusetts Eye and Ear Infirmary,
Fluorescein Lab
243 Charles Street, Boston, Massachusetts 02114
(617) 573-3579 FAX (617) 573-4454
charlene_callahan@xxxxxxxxxxxxxxxx
-----Original Message-----
From: FreeLists Mailing List Manager [mailto:ecartis@xxxxxxxxxxxxx]
Sent: Wednesday, February 09, 2011 1:09 AM
To: optimal digest users
Subject: optimal Digest V2 #20
optimal Digest Tue, 08 Feb 2011 Volume: 02 Issue: 020
In This Issue:
[optimal] Re: Question on fluorescein dosages
[optimal] Re: Inexpensive slit lamp camera solution?
[optimal] Re: Inexpensive slit lamp camera solution?
----------------------------------------------------------------------
From: Ethan Priel <prieleye@xxxxxxxxxxxxxxxx>
Subject: [optimal] Re: Question on fluorescein dosages
Date: Wed, 09 Feb 2011 09:38:12 +0200
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Denice good morning.
=20
The term simultaneous angiography does not NECESSARILY mean that the =
dyes
are injected at the same time.
=20
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=20
(FA +ICG) and get both images 'side by side'.
=20
The benefits include the ability to compare locations of pathology
accurately while bringing up the images side by side.
=20
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
=20
I guess I=92m not framing my question well
=20
If the concept is =93SIMULTANEOUS FA/ICG=94 then wouldn=92t the =
injection have to
be simultaneous as well?
=20
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
=20
Denice hi,
Don=92t use a stopcock.
Inject Fluorescein=20
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=20
Disconnect tubing, patch with a bit of pressure.
Bob, uncles, etc.
=20
Now, I don=92t really get your query.
Why Fluorescein first ? many advantages, you want the list >>?>????
=20
Is it beneficial to have a separate, full =3Dresolution for each =
transite
phase/???
=20
Ethan
=20
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
=20
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?
=20
Inquiring minds wish to know=85.
=20
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
=20
Denice-
There are indeed different dosages for different purposes of ICGA.
=20
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.
=20
For choroidal inflammatory diseases we need more of the late-stage =
photos,
so larger doses are used.
=20
In general we use the whole vial in most cases.
=20
Regarding the simultaneous bolus vs. separate, here too the nature of =
the
study dictates the mode of injection.
=20
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.
=20
All the best,
=20
Ethan
=20
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
=20
Dear Optimal Tribe
=20
Am looking for publication, survey, etc on the merits of Simultaneous =
FA/ICG
cocktail
=20
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?
=20
We=92re using 2 cc=92s 25% FA ( 250mg/ml) and 4.5 cc reconstituted ICG =
in same
syringe. Works great.
=20
Retina docs telling me we must go back to old school of separate bolus,
stopcock, separate syringes. Wouldn=92t that defeat the purpose of
SIMULTAENOUS FA/ICG? =20
=20
Citation in =93Ophthalmic Photography=94 Saine, Tyler =93for =
simultaneous FA/ICG
dosages of the two dyes are combined in the same syringe=94. Exact =
dosages
not mentioned.
=20
I=92d sure like to have a stronger argument than empirical evidence visa =
vis
great photos on the Spectralis to make my case.
=20
Thanks
Denice
=20
=20
=20
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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From: "Thomas C. Monego" <Thomas.C.Monego@xxxxxxxxxxxxx>
Date: Tue, 8 Feb 2011 08:18:33 -0500
Subject: [optimal] Re: Inexpensive slit lamp camera solution?
Sarah,
Topcon has a bottom line slit lamp camera our optoms are using. Several years
ago it was right around $5K, so would probably be more now, but worth a look,
really still frame video. No real strobe but has a background light which is
missing on a conversion.
Tom
-----Original Message-----
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Sarah Moyer
Sent: Monday, February 07, 2011 5:48 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Inexpensive slit lamp camera solution?
Optimalers,
I am looking for an inexpensive slit lamp camera solution. I've heard
of systems where you can take out the eyepiece of a slit lamp and then
put in an adapter that will allow you to connect it to your camera.
The photographer/doctor would then take a picture using the capture
button on the camera.
Does anybody know who makes these adapters? And which cameras are
best to connect them to?
I'm open to other inexpensive (hoping for less than ~$5,000) slit lamp
camera solutions as well!
Thanks,
Sarah
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------------------------------
Subject: [optimal] Re: Inexpensive slit lamp camera solution?
Date: Tue, 8 Feb 2011 08:56:37 -0600
From: "Doug Blanchard" <Doug.Blanchard@xxxxxxxxxxx>
Sarah,
A few years ago I found myself in the same spot. After a ton of research, and
not wanting to spend a lot of money, I built my own using a pre existing Haag
Streit BQ.
The adapter is an Accu Beam II with a beam splitter from TTI Medical. I
attached a Canon 30D because it gave me the ability to shoot with a foot pedal.
I does require an external fill light and I can send makes and models of a
couple I have.
The Images are great with the 30D being 6 megapixel. I started out shooting
RAW, The images were incredible, but hard to store and work with. When we
went live with EMR, I bumped them down quiet a bit and ended up with a very
small very manageable image that displays very well on screen.
In the beginning I used the capture software that came with the 30D. It worked
great but I had to create and name a folder for each Pt. before a shoot. A
little involved, but worth it at the time.
Let me know if you need more info, or would like pics of my setup.
Doug Blanchard, C.R.A.
Director of Imaging Services
Mann Eye Institute and Laser Center
Office 713.275.2429
Fax 713.275.2490
Achieve 20/20 at Mann Eye Institute
Join Us On Our Social Networks
-----Original Message-----
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Sarah Moyer
Sent: Monday, February 07, 2011 4:48 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Inexpensive slit lamp camera solution?
Optimalers,
I am looking for an inexpensive slit lamp camera solution. I've heard
of systems where you can take out the eyepiece of a slit lamp and then
put in an adapter that will allow you to connect it to your camera.
The photographer/doctor would then take a picture using the capture
button on the camera.
Does anybody know who makes these adapters? And which cameras are
best to connect them to?
I'm open to other inexpensive (hoping for less than ~$5,000) slit lamp
camera solutions as well!
Thanks,
Sarah
------------------------------
End of optimal Digest V2 #20
****************************
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- » [optimal] Re: optimal Digest V2 #20 - Callahan, Charlene
