1. FFA & ICG Ewan McCallum GHH 15/7/14

2. Overview FFA & ICG – Background – Examples – Background – Examples

3. FFA 20% free in plasma Excited by blue light to emit yellow light Cannot diffuse through tight junctions – RPE – Retinal vessel endothelium NB – fluorescein leaks freely into aq/vit therefore white structures pseudofluoresce

4. FFA 5 phases – Choroidal – v brief as leaks fast – Arterial – CRA fills 1 sec later – Capillary – peri foveal network most visible due to luteal pigment. 500micron FAZ – Venous – early laminar flow – Late – 10-15mins dye only left in structures where it has leaked. Drusen, window defects and inactive scars fade, i.e show up active disease

5. ICG 800nm wavelength, penetrates retinal layers Tightly bound to plasma proteins so stays in vessels Allows better view of choroidal circulation

11. Polypoidal choroidal vasculopathy Sub type of AMD 15% of all ‘CNV’ Steep walled haemorrhagic PED on OCT PDT +/- anti VEGF best Need ICG to diagnose most (wide angle to pick up more)

14. Retinal angiomatous proliferations Sub type of AMD Large serous PEDs extensive areas of small drusen leak aggressively Respond poorly to anti VEGF – NB patient expectation Up to 100% of fellow eyes affected 37% within 3 years

19. MACTEL Not an ‘AMD’ Important as does not respond to anti VEGF

23. CSR Can be confused with AMD as exudative maculopathy Especially if chronic/recurrent Chronic can develop into nAMD or IPCV

24. Diabetes