Adverse effects of fluorescein angiography in hypertensive and elderly patients

Abstract

IntroductionFundus fluorescein angiography (FA) is one of the most commonly used imaging procedures in ophthalmology. Although sodium fluorescein is a relatively safe drug, adverse effects including death have been reported in the medical literature (Yannuzzi et al. 1986). Despite this, there are no firm criteria for departments undertaking FA. As a result, there appears to be some variation in opinion amongst practitioners as to which patients the test is suitable for. In a questionnaire survey carried out by our department of clinical practice in 110 ophthalmic imaging units (R. Hancock, unpublished data), 53 responders (57%) cited hypertension as an important factor in deciding whether a patient underwent FA. Other departments also referred to advanced age, particularly > 90 years, as a relative contraindication.Therefore, we carried out a retrospective study of patients who had attended our department. We looked for adverse effects and, in particular, their relationship to age and hypertension. Materials and MethodsA retrospective analysis was undertaken of patients who had undergone FA at the Department of Ophthalmology, University Hospitals of Aintree, Liverpool, UK. Each patient attended the department on the date of his or her investigation as an outpatient and was managed according to a set protocol. Informed consent was obtained when the test was first ordered by a doctor. On arrival, a medical history was taken by a specialist nurse using a set questionnaire. This included information on age, gender, past medical history, allergies and the number of previous FA investigations. In addition, the patient's pulse and blood pressure were measured and recorded approximately 20 mins before and after the procedure. ABSTRACT.Purpose: To evaluate adverse effects in patients undergoing fundus fluorescein angiography (FA), and to assess the level of these adverse effects in hypertensive and elderly patients. Method: We carried out a retrospective study of 358 patients undergoing FA. They were assessed for adverse effects and their relationship to medical history, pre-and post-FA blood pressure and age. Results: The overall adverse reaction rate (AR) was 11.2%, the majority (80%) of which involved nausea. There were no mortalities and no cases of anaphylaxis or cardiac arrest. Hypertension (systolic or diastolic) did not increase the AR. Interestingly, raised initial systolic blood pressure (BP) ‡ 160 showed a statistically significant decreased AR compared with that for BP < 160 (7% versus 15%, respectively; p ¼ 0.04). There was no statistical correlation between AR and age. Conclusions: FA is a relatively safe procedure, but serious side-effects have been reported in the past and therefore adequate measures need to be in place to cope with such emergencies. In our study, there was no increase in the incidence of adverse effects in patients who were hypertensive or elderly. Therefore, these patients should not be denied an important diagnostic procedure that may improve their quality of life purely because of hy...

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