Fluorescein Angiography

What is Fluorescein Angiography?

Fluorescein angiography is a test which allows the blood vessels in the back of the eye to be photographed as a fluorescent dye is injected into the bloodstream via your hand or arm. It is particularly useful in the management of diabetic retinopathy and macular degeneration. The test is done to help the doctor confirm a diagnosis, to provide guidelines for treatment, and to keep a permanent record of the vessels at the back of the eye. Fluorescein sodium is a highly fluorescent chemical compound that absorbs blue light with fluorescence. Although commonly referred to as fluorescein, the dye used in angiography is fluorescein sodium, the sodium salt of fluorescein. A common misconception is that it is a 'vegetable dye' rather than a synthetic.

How Is The Procedure Done?

The pupils will be dilated with eye drops and the yellow dye is injected into a vein in your arm. During the injection, there can be a warm feeling or a hot flush can be experienced. This only lasts seconds and then disappears. Following the injection, photos are taken quickly over a period of about 60 seconds as the dye enters the vessels at the back of your eye. The lights flashed at you may appear bright but will NOT damage your eyes. It is common for the skin to be pale yellow and the urine colored fluorescent yellow after the procedure and these may take two days to wear off.
now: this is a FA taken from my patient ,what is your diagnosis? 




Open Angle Glaucoma, My 35y f patient newly diagnosed

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Wart


Types of Warts and their Causes and Treatment

Warts are caused by a virus called Human Pappilomavirus (HPV), and there are different types that a person can get infected with. They are generally small, rough formations, usually found on the hands and feet. However, they can also appear on other parts of the human body. They can look like a cluster of cauliflowers, a solid bump, or a threadlike piece of skin.

Common Types of Warts

The common wart (Verucca vulgaris) is a raised wart called papules or plaques. These warts have a rough surface and are usually seen on the hands, elbows, and knees.

Flat Warts

The flat wart (Verucca plana) is a small, smooth, and flat-topped wart. This is skin-colored and can appear on the face as well. Flat warts easily spread through shaving. They are most common in teens and children. These warts usually appear on the face, forehead, hands, arms, or neck. Usually, there are multiple warts in the same area, which makes them difficult to treat. Treatment is with non-prescription drugs, but it is not always necessary because they tend to go away on their own. Whether treatment will be effective depends on the wart size and how deep it has grown. If generic drugs do not help, it is advisable to apply stronger substances like salicylic acid, retinoin, or glycolic. You may have to use cryotherapy and freeze the skin with liquid nitrogen. The final option is electric surgery. After such treatment, they simply drop off.

Plantar Warts

The plantar wart (Verucca pedis) is usually seen on the soles of the feet. Plantar warts are hard, thick, and sometimes painful lumps, especially in weight-bearing areas. They usually have black specks in the center. These warts are sometimes confused with corns or calluses.
Plantar warts can be extremely painful and very ugly. They look like tiny lesions on the foot sole and sometimes on the toes. When they first begin to develop, they look like small black marks, but as they grow, they start to look like brown cauliflowers. When you walk, you push them into the skin, which is why they hurt. People complain that it is like walking on a stone. The type of human papilloma virus (HPV) that causes these warts is transmitted through direct contact with the virus. It thrives in pool decks, shower rooms and other moist environments. Many plantar warts go away by themselves with time. They are treated with salicylic acid, which is to be applied daily on the wart area for around a month.

Genital Warts

Genital warts (Verucca acuminata, Condyloma acuminatum) are also called venereal warts. Genital warts appear only in the genital area of both men and women: in and around the vagina, cervix, anus, penis, and scrotum. These warts can resemble the common wart or they can be small papules and skin colored. They can also vary in size; from being tiny (so that they are sometimes unnoticeable to the naked eye), or they can grow large in size and even obstruct urinating.

Oral Warts

Another common type is oral warts, which can appear anywhere on the lips or inside the mouth. They are rough and lumpy. This variety infects only humans and is spread by kissing and oral sex. Poor hygiene is another common cause. Oral warts can lead to cancer, so they should be taken very seriously. Treatment options include surgical excision, injecting them with interpheron alpha, and freezing with cryotherapy.

Filiform Warts

Filiform warts, also known as facial warts, can be spread by sharing towels. If they are not removed they multiply. You do not contract the virus every time you come into contact with an infected person. Some people never get infected. It depends on the person’s age and immune system. This goes for all wart types – younger people and people with a weaker immune system are more susceptible to transmission. Filiform warts usually occur on the eyelids, neck and lips. Symptoms include bleeding and itching. You cannot remove these warts on your own. Salicylic acid is effective in combination with freezing, laser light, or surgical excision. Unfortunately, the last method leads to scarring. At any rate, you must consult your doctor.

Periungual Warts

Periungual warts occur under or near fingernails and toenails. They start out very small, but after several weeks, they turn into rough pea-size bumps. They are commonly found in people who pick and bite their nails because the broken skin surfaces are conducive to infections. They can spread to other parts of the body if your hygiene is poor. Treatment methods are similar – salicylic acid, laser, and freezing.
The type of wart that develops should be diagnosed by a doctor. A biopsy can also confirm the diagnosis but is seldom required.

Causes of Warts to Appear

Warts are caused by the Human Pappilomavirus (HPV) which attacks the skin and immune system of the infected person. There are cases in which a person has come in contact with HPV but does not develop warts; this person could be having a strong immunity.
Each type of wart has a specific HPV strain that causes it. Common warts appear after infection with HPV types 2 and 4. Plantar warts are mostly caused by HPV type 1. Genital warts, on the other hand, are caused by HPV types 6 and 11. The flat warts develop after infection with HPV types 3, 10 and 28.

Treatment of Warts

The treatment of warts can vary according to type, location, and the condition of the patient. Pregnant women who have warts should not treat them with OTC drugs as they contain chemicals that can cause birth defects.
Warts are not curable, but they can be removed. They can disappear after a few months and can always reoccur. Doctors remove warts through cauterization or burning of the growth, laser treatment, and other methods. Cryosurgery, in particular, freezes warts using liquid nitrogen and will require a couple of treatments before the warts fall off.
Warts can be prevented though, and a HPV vaccine has been developed to prevent any diseases caused by the virus.

Evisceration, Enucleation and Exenteration



Evisceration, Enucleation, and Exenteration are the three main surgical techniques by which all or part of the orbital contents are removed.
Evisceration is the removal of the contents of the globe while leaving the sclera and extraocular muscles intact.
Enucleation is the removal of the eye from the orbit while preserving all other orbital structures.
Exenteration is the most radical of the three procedures and involves removal of the eye, adnexa, and part of the bony orbit.
Evisceration: is usually indicated in cases of endophthalmitis unresponsive to antibiotics and for improvement of cosmesis in a blind eye
Enucleation: is indicated for the above two conditions as well as for painful eyes with no useful vision, malignant intraocular tumors, in ocular trauma to avoid sympathetic ophthalmia in the second eye, in phthisis with degeneration, and in congenital anophthalmia or severe microphthalmia to enhance development of the bony orbit.
Exenteration: is indicated mainly for large orbital tumors or orbital extension of intraocular tumors.
Issues to consider (and to discuss with the patient) are the irreversibility of the visual loss, the fact that the globe will be removed and the need for a prosthesis in a couple of months time, the different types of  implants and the pros and cons of each, postop motility and rehabilitation, and the complications of the procedures (e.g. extrusion, transmission of viral infections with donor grafts, infection of the prosthesis....). It's also very important to recommend safety glasses for the fellow eye (e.g. polycarbonate lenses) as well as a regular eye checkup.