Evaluation of Potential Systemic Adverse Events Related to Fluorescein Angiography in Pediatric Patients

Abstract

Purpose : Existing studies on fluorescein angiography (FA) safety primarily involve adults. Reported adverse effects of FA in adults include nausea, vomiting, urticaria, anaphylaxis and cardiac arrest, which usually manifest clinically <24 hours post-FA. This study aims to evaluate the systemic safety profile of intravenous fluorescein dye injection in pediatric patients.

Methods : A retrospective chart review of patients aged 0-18 years who underwent examination under anesthesia with FA between 2010 and 2015 was performed. Detailed intra- and peri-operative physiological parameters (Table 1) from Anesthesia Information Management System (AIMS) were reviewed. Data points in AIMS were generated every 15 seconds, other than systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), which were generated every 150 seconds. Peri-injection effects of intravenous fluorescein were evaluated by two-tailed paired t-test comparison of mean five-minute pre-injection and five-minute post-injection AIMS data. Significant adverse events <24 hours after FA were evaluated by new documented skin rash, cardiorepiratory compromise, delay in extubation, or unexpected readmission in patients’ medical records.

Results : 85 visits by 65 patients were included. AIMS data was available for 70 of 85 visits. 27 visits had an exact documented time of fluorescein injection for comparison of mean five-minute pre- and post-injection physiological parameters: Heart rate (p=0.64), respiratory rate (p=0.34), MAP (p=0.74), SBP (p=0.65), DBP (p=0.93), oxygen saturation (p=0.38), tidal volume (p=0.64), peak inspiratory pressure (p=0.2), peak end-expiration pressure (p=0.18), sevoflurane rate (p=0.2), and end-tidal CO2 levels (p=0.63). One of 85 visits had significant medical events within 24 hours of FA. The apnea, bradycardia and desaturation experienced by this preterm infant after FA had also occurred prior to FA, and were not causally associated with FA. Mean age at time of FA of the patients included in the study was 2.52 years, with chronologic age range of 4 weeks (32 weeks postmenstrual age) to 16.2 years. Of all visits, most common diagnoses were retinopathy of prematurity (44.7%), Coat’s disease (8.2%), and familial exudative vitreoretinopathy (7.1%).

Conclusions : In this study, no significant systemic adverse events were found to be associated with intravenous FA in pediatric patients.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.