COMPLICATIONS OF INTRAVENOUS FLUORESCEIN INJECTIONS

Lawrence A. Yannuzzi, MD

Since 1851, when Helmholtz invented the direct ophthalmascope and became the first to visualize the human fundus, subsequent technological advances have enhanced the ophthalmologist's ability to examine the posterior segment critically. One of the most important development was the advent of fluorescein angiography. Since its inception in the 1960s, this technique has become an invaluable tool in the diagnosis and treatment of various ocular conditions.

Fluorescein angiography is performed using an intravenous injection of a dye, sodium fluorescein, followed by serial fundus photography. Sodium fluorescein is a relatively low-molecular-weight, highly water-soluble compound that exhibits the physical property of fluorescence. When exposed to light of a wavelength between 465 and 490 nm (blue), the compound emits light at a wavelength of 520 to 530 nm (green-yellow). Using properly matched exciting and barrier filters, the retinal and choroidal vasculature, as well as fundus abnormalities, can be critically assessed. Fluorescein angiography has accordingly supplied ophthalmologists with important pathophysiological insight and an essential guideline to the medical and laser treatment of numerous chorioretinal diseases.

In nearly 30 years of clinical use, the intravenous injection of fluorescein has proved to be a fairly safe procedure. Although several side effects have been reported in the literature, serious or life-threatening complications are extremely rare. In this article, we will attempt review the nature and severity of complications of fluorescein angiography, discuss the frequency of their occurrence and outline appropriate therapeutic considerations.