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Alec Lee Amram, Fuad Makkouk, Stanley Tyler Pace, Clint Kellogg, Ahmed Elkeeb; Sublingual/Transmucosal Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4995. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Intravenous fluorescein angiography (IVFA) remains the gold standard by which ophthalmologists diagnose and manage a vast array of ocular pathology. Unfortunately, a significant proportion of patients are unsuitable for intravenous medication administration. While oral fluorescein angiography (OFA) remains a safe, viable option for retinal vascular imaging, oral medication delivery has a number of drawbacks compared to transmucosal systems. To date, no published data exists evaluating the feasibility of a transmucosal fluorescein delivery system. The aim of this pilot study was to evaluate sublingual/transmucosal fluorescein angiography (SLFA) and to compare this to both IVFA and OFA in terms of dye appearance onset, image quality, and adverse effects encountered.
Healthy volunteers were selected with no history of medical or ocular conditions to undergo fluorescein angiographic imaging studies following intravenous, oral, and sublingual/transmucosal fluorescein administration during three separate study visits. A questionnaire was administered following each study visit. Main outcome measures included time to dye appearance, image quality (smallest order branch retinal artery visualized and foveal avascular zone clarity), subjective taste, and side effects experienced including nausea, vomiting, pruritus, skin yellowing, other skin reactions, and anaphylaxis.
Three male and nine female subjects enrolled and underwent all three imaging studies. Average dye appearance time was 26.6 seconds for IVFA, 297.8 seconds for OFA, and 335.9 seconds for SLFA. Image quality graded by smallest order branch artery was grade 2 or better in 100% of IVFAs, 100% of OFAs, and 75% of SLFAs. FAZ visualization was grade 1 or better in 100% of IVFAs, 100% of OFAs, and 58% of SLFAs. Mild adverse effects were experienced in 16.7% of IVFAs, 33.3% of OFAs, and 8.33% of SLFAs. No serious adverse events, including hospitalization or anaphylactic reaction, were experienced at any study visit.
Sublingual/transmucosal delivery for fluorescein angiography is a viable option that, with further development, may represent a suitable alternative to intravenous or oral fluorescein angiography.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Sublingual Fluorescein Troches. Package containing 20 transmucosal 300 mg sodium fluorescein troches.
Image Comparison. (A) IVFA, (B) OFA, and (C) SLFA final images recorded in the same patient, recorded five minutes after initial dye appearance.
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