Albrecht v. Graefes Arch. klin. 205, 229--235 (1978)

e x p . Ophthal.

Graefes Archiv fo,klinischeundexperirnentelPe Ophthalmologie 9 by Springer-Verlag 1978

Anterior Segment Fluorescein Cineangiography* Michael H. Kottow**, Norm Jednock, and Jerry H. Sewell University of Illinois Eye and Ear Infirmary, Abraham Lincoln School of Medicine, Chicago, II. 60612, USA

S u m m a r y . We have developed a technique for performing anterior segment fluorescein cineangiography. Illumination is obtained with a halogen lamp of a standard slide projector that is fitted with a blue excitation filter. Cinematography occurs with a movie camera fitted with an absorption-type barrier filter and mounted to a photo slit lamp through a cineadapter. The technique has been successfully employed with animals, and it is anticipated that the light levels used are tolerable and safe for application with humans.

The possibility of producing cinematographic recordings of the ocular fundus has long been known [1], but was not a reality until choriorerinal studies using contrast dyes were introduced [2, 3]. Initially, only insufficient light sources were available, which limited the filming speed and made fluorescein cineangiography impossible because of the dark filters required [4, 5]. Modifications were subsequently introduced to obtain a more powerful and permanent light source [6, 7]. These entailed bulkier equipment and more complicated cooling systems, as well as potential light toxicity to the retina. In addition, the high light levels became too intense for comfortable or even tolerable application in humans, and, for the most part, had to be restricted to experimental use in anesthetized animals [ 8 - 1 1 ] . Alternatively, strobe-controlled rapid-sequence flashes were employed, which resulted in more tolerable light levels [ 1 2 - 1 4 ] , but still required a large energy input to feed the cooling system. Halogen lamps also were used successfully for fundus cineangiography, but they too resulted in high, often intolerable light levels [ 15]. Continuous, low luminance,

* Supported in part by an unrestricted grant from Research to Prevent Blindness Inc, New York, and a research grant from the Illinois Society for the Prevention of Blindness, Chicago. * * Address f o r offprint requests: Dr. M. Kottow, Klinisches Institut ffir Experimentelle Ophthalmologie, Abbestr. 2, D-5300 Bonn-Venusberg, Federal Republic of Germany 0065-6100/78/0205/0229/$

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light sources have been developed or modified [16], but fundus cineangiography has remained a cumbersome and relatively little used technique. Anterior segment fluorescein angiography had developed along similar technical lines as fundus angiography, but cineangiography appears only to have been mentioned as a possibility, without having been further developed [17]. With the increasing importance of vascular disorders affecting the anterior segment [ 18], the application of cinematographic documentation to fluorescein angiography of these structures seems potentially useful.

Material and Methods Adaptations for cineangiography were carried out on a photo slip lamp. A 35-ram movie camera was attached to a beam splitter by means of a 74-mm f4 cineadapter, so that focusing could be performed through the ocular system or by means of the movie camera's viewer. The camera's optic system was fitted with an absorption-type barrier filter. The illumination source was a slide projector equipped with its standard 250-W halogen lamp. Different slide projector types were employed with comparable results. The projector was placed at an angle approximately 30 ~ to the slit-lamp housing, and about 30 cm away from the eye. A 5- x 5-mm interference-type excitation filter was inserted into the slide carrier of the projector. This filter had a transmission peak at 495 nm and a transmittance of 82%. With this filter in place, the excitation source gave a continuous light emission of 500 to 1,100 foot candles, which varied according to the angulation and distance of the slide projector to the eye (Fig. 1).

C

Fig. 1. Instrumental setup for anterior segment fluorescein cineangiography. C: Movie camera. A: Cineadapter. S: Beam-splitter. P: Slide projector. F Filter holder

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A black and white reversal panchromatic film with a sensibility of 400 ASA was employed, The filming speed could be adjusted from 16 to 24 frames per second. Adult albino rabbits were anesthetized and placed in a small-animal rack in front of the camera. A 10 % fluorescein solution (1.5 ml) was injected into the middle ear vein. Filming began as the injection was completed, and continued uninterrupted for the first three minutes. In addition, late sequences were recorded intermittently up to ten minutes after the administration of fluorescein (Figs. 2--5).

Comment

The advantage of the above-described system is its ready availability, which does not require costly equipment or major adaptation facilities. Halogen lamps have a light-emission spectrum that is shifted toward the shorter wave-lengths, so that a greater part of the light energy can be taken advantage of usefully [15]. Similar amounts of light reaching the eye have been found to be tolerable, although not pleasant, to the dilated eye [9], so that it is anticipated that the light levels of the present system will be acceptable to the patient's nondilated eye.

Fig. 2. Cineangiographic sequence of fluorescein filling of albino rabbit's iris vessels

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Fig. 3. Cineangiographic recording of fluorescein filling of pigmented rabbit's iris vessels

Fig. 4. Cineangiographic recording of late stage of albino rabbit's iris after paracentesis. Note progressive filling of anterior chamber with extravasated fluorescein

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Fig. 5. a Arterial phase of rabbit iris angiography. By enlarging cineangiographic negative detailed picture can be obtained, b Late arterial phase of rabbit iris angiogram. Good detail is observed in picture obtained by enlarging cineangiographic negative

One of the basic problems involved in ocular cineangiography is the potential retinal toxicity of high and sustained luminance levels [ 19]. When using high pressure, continuously burning xenon lamps, the amount of light impinging upon the retina is 30 mW/sq cm, which is comparable to the light energy of indirect ophthalmoscopy [20]. In anterior segment angiography, where the pupil is miotic, substantially less light reaches the retina. Anterior segment fluorescein cineangiography has a number of potential applications. Scleroconjunctival outflow channels in glaucomatous patients, especially after filtering procedures, have been studied with fluorescein injected into the anterior chamber [21], and it is probable that these investigations can be more accurately performed with cineangiographic recording. Circulation characteristics of the conjunctival vessels in glaucoma, diabetes, sickle cell disease, and other disorders might be better analyzed with this more exact method. Blood flow in the iris under different intraocular pressure conditions, as well as iridial circulation dynamics in diabetes, retinal vein occlusions, and other vascular disorders are only some of the potential applications of this method.

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References

1. Pavia, J.L.: La cinematografia del fondo de ojo: Su tecnica, su objeto. Rev OtoNeuro-Oftal. 8, 201--205, (1933) 2. Chao, P., Flocks, M.: The retinal circulation time. Am. J. Ophthalmol. 46, 8 - 1 0 (1958) 3. Flocks, M., Miller, J., Chao, P.: Retinal circulation time with aid of fundus cinephotography. Am. J. Ophthalmol. 48, 3 - 6 (1959) 4. Bailey, P.J., Swan, K.C. : Cinematography of human vessels. JAMA 170, 1373-- 1375 (1959) 5. Talbot, G.D., Frayser, R., Tomlin, H.: Retinal cinematography using modified Zeiss camera. Arch. Ophthalmol. 69, 770-772 (1962) 6. Linhart, J.W., Mclntosh, H.D., Heyman, A., Hart, L.M.: Clinical experience with fluorescence retinal cinematography. Circulation 29, 577~-582 (1964) 7. Dollery, C.T., Henkind, P., Paterson, J.: Retinal microemboli: Cinefluorescence angiography. Trans. Ophthalmol. Soc. UK. 85, 271--273 (1965) 8. Oberhoff, P., Evans, P.Y., Delaney, J.F.: Cinematographic documentation of retinal circulation times. Arch. Ophthalmol. 74, 7 7 - 8 0 (1975) 9. Hyvarinen, L.V.M., Nieminen, H.: Fluorescence cinematography of the ocular fundus. Acta Ophthalmol. (Kbh.) 45, 100--105 (1967) 10. Kulvin, M.S., David, N.J.: Experimental retinal embolism: Studies with high speed fluorescein cinematography. Arch. Ophthalmol. 78, 774-787 (1967) 11. Wessing, A., Spitznas, M., Littman, G.: A new camera for fluorescein angiography, in Shimizu K. (ed.): Proceedings of the International Symposium on Fluorescein Angiography (ISFA), Tokyo 1972. pp. 15--19, Tokyo: Igaku Shoin Ltd, 1974 12. Behrendt, T.: Synchronous flash motion picture camera. Am. J. Ophthalmol. 6 3 , 9 4 6 - 9 5 0 (1967) 13. Leverett, S.D., Jr., Bailey, P.F., Holden, G.T., Cheek, R.J. : Fundus cinephotography during gravitational stress. Arch. Ophthalmol. 83, 223-231 (1970) 14. Young, S.: High speed angiography. Med. Biol. Illus. 25, 199-204 (1975) 15. Gnad, H.D.: Ein Verfahren zur Fluoreszenzkinematographie der menschlichen Netzhaut. Graefes Arch. Klin. Ophthalmol. 182, 8 2 - 8 8 (1971) 16. Haining, W.M., Wright, M.P., Perkins, R.E.: Cinefluorography. Int. Ophthalmol. Clin, 14, 15-28 (1974) 17. Matsui, M., Justice, J. Jr., Parel, J.-M.: Some improved methods of anterior segment fluorescein angiography. In: Shimizu K. (ed.): Proceedings of the International Symposium on Fluorescein Angiography (ISFA), Tokyo 1972. pp. 273--280 Tokyo, Igaku Shoin Ltd. 1974 18. Kottow, M.H.: Anterior segment fluorescein angiography. Baltimore: Williams & Wilkins Co., (to be published) 19. Vassiliadis, A.: Illumination threshold, in De Laey JJ (ed.): International Symposium on Fluorescein Angiography, Ghent 1976. pp. 81-84. The Hague: Dr. W. Junk Publishers, 1976 20. Pomerantzeff, O., Govignon, J., Schepens, C.L.: Indirect ophthalmoscopy. Is the illumination level dangerous? Trans. Am. Acad. Ophthalmol. Otolaryngol. 73,246-251 (1969)

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21. Tenner, A., Jaeger, W.: Demonstration of aqueous outflow by fluorescein injection into the anterior chamber after various types of glaucoma operations. In: De Laey JJ (ed.). International Symposium on Fluorescein Angiography, Ghent 1976. pp. 85-89. The Hague: Dr. W. Junk, Publishers 1 9 7 6 Received November I, 1977

Anterior segment fluorescein cineangiography.

Albrecht v. Graefes Arch. klin. 205, 229--235 (1978) e x p . Ophthal. Graefes Archiv fo,klinischeundexperirnentelPe Ophthalmologie 9 by Springer-Ver...
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