<p>Immediate Reactions to Fluorescein and Indocyanine Green in Retinal Angiography: Review of Literature and Proposal for Patient’s Evaluation</p>

Abstract

Introduction: Contrast rapid sequence angiography with fluorescein or indocyanine green (ICG) is a diagnostic procedure commonly used in ophthalmology. Adverse reactions to fluorescein and ICG are rare and may be classified as toxic, of hypersensitivity and nonspecific. The evaluation and management of a patient with an adverse reaction is a challenge for the majority of ophthalmologists, as is the assessment of risk factors that may contraindicate the procedure. Purpose: We aim to review the concepts underlying adverse reactions to fluorescein and ICG, especially those of hypersensitivity, and present a proposal or the evaluation of the patients in need to perform retinal angiography and for the treatment of immediate reactions to fluorescein and ICG. Methods: The available literature was examined using PubMed-Medline, and using the MeSH terms "fluorescein", "Indocyanine green", "ophthalmic dyes", "retinal angiography", "adverse reactions", and "allergic reaction". Conclusion:This review may help ophthalmologists to identify patients with higher risk of a hypersensitivity reaction and give them tools to recognize patients with suspected hypersensitivity that may benefit from an allergy study.

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“…Finally, although fluorescein has a long record of use in ophthalmology and neurosurgery, adverse reactions are possible. However, the estimated incidence of adverse reactions is below 5%, and severe adverse reactions occur in less than 0.01% [ 40 ].…”

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“…FA and ICGA are invasive techniques that require intravenous dye injection, which can result in hepatic, renal, and allergic complications [23]. The incidence of adverse reactions is 0.05% for ICG and 5% for fluorescein [24]; however, FA is routinely performed in patients with advanced diabetic retinopathy, many of whom have diabetes-related renal compromise. Cases of hypotensive shock and death have been reported [25].…”

The Fluorescent Patient: An Unusual Effect of Fluorescein Angiography

“…The incidence of adverse reactions in those with a history of allergic diseases seems to be higher Nausea, vomiting, urticaria, localized reactions [3]; allergy [17,18]; hypersensitivity [19]; all [20] Dermatological complications…”

“…Several proposed mechanisms: vasovagal reaction, drug allergy, anxiety-related medullary sympathetic discharge, direct vasospastic toxic effect, drug contamination IgE-mediated hypersensitivity Hypersensitivity, same as above [17]; hypersensitivity, same as above [19]; all [20] Severe nonallergic reaction…”