Thoughts on Oral Administration of Angiograhic Dyes https://www.opsweb.org/forums/posts.aspx?topic=1462693 Sun, 19 Jul 2026 02:07:32 GMT Mon, 24 Dec 2018 16:27:19 GMT Copyright © 2018 Ophthalmic Photographers' Society Thoughts on Oral Administration of Angiograhic Dyes https://www.opsweb.org/forums/posts.aspx?topic=1462693 https://www.opsweb.org/forums/posts.aspx?topic=1462693 Hello fellow OPS members,

In my practice we recently had a situation where we could not find a vein on a patient we were attempting to perform an FA/ICG on. 

It was suggested to the physician that perhaps the pt could drink the dye, as we have done this sparingly in the past with FA dye. The physician was hesitant, however, because of the presence of ICG dye in the mix.

So, my question to you all is: does anyone have any experience with or heard anything about Oral Administration of ICG dye and having a successful study performed?

Any thoughts would be appreciated.

]]> Thu, 29 Nov 2018 18:14:32 GMT https://www.opsweb.org/forums/posts.aspx?topic=1462704 https://www.opsweb.org/forums/posts.aspx?topic=1462704
We have not uncommonly performed oral FA without incident and surprisingly good results in the course of year for impossible venipuncture ( of course, when possible, OCTA !! is your guy here ) With today's sensitive laser based systems, imaging of the vasculature can usually be done within a window of 5-15 minutes depending on many factors. Size of patient, amount of dye ingested, pigmentation of the patient's RPE, patient's particulars regarding their blood barriers, etc the results can be more than clinically sufficient ( would I put these in my portfolio? No, but the goal here is to answer the clinical question with whatever means is available)

I had a classic case this month. Obese patient with impossible venipuncture, rule out CNVM. OCTA answered the question quite easily and this gal is sold! on the as yet, limited applications of OCTA

Hope this helps. Feel free to contact me off line at cpmceyelab@sutterhealth.org]]> Thu, 29 Nov 2018 19:06:59 GMT https://www.opsweb.org/forums/posts.aspx?topic=1462804 https://www.opsweb.org/forums/posts.aspx?topic=1462804
Is it possible to simply place the liquids in a gel capsule and have them swallowed to avoid some of the oral factors?

For Sodium Fluorescein the flavor is horrible. I believe there's a paper on the OPS site that covered it, otherwise I had seen a study covering it where a site had a series of patients with a common disease which could cause a visual disorder but also created horrible veins throughout their body making venipuncture nigh impossible. The group used orange juice or coffee to mask some of the flavor but found in some instances that the dye took a very long time, but also provided very poor transit images. It worked for what they needed it for, but wasn't the most effective thing out there.

I've also seen where in a foreign country they skipped venipuncture and went for oral administration as their standard of care. I believe both groups were using 5ml of 10%, but I've seen somewhere that oral administration used 10ml of 10%. I'd be more hesitant with the 10ml.

As it is, with 2.5ml of 10% we sent someone to the ER this year when they started having heart issues 3 minutes into the test.

Obviously health factors can be a huge influence.

Have you tried using smaller needles? I typically use 23 gauge butterflies for close to 90% of the venipuncture I perform. 9% of the time (roughly) I'll use 25 gauge. One those horribly difficult patients I'll try a 27 gauge. We had a patient who'd been through multiple rounds of cancer treatment and had horribly damaged veins, 27 gauge was the trick for that patient. On the other hand, a former drug abuser who had been shooting up 5-10 times a day toward his/her peak had horrible veins and none of the needles were an option, none of the veins worked for it. :(

]]> Fri, 30 Nov 2018 08:05:08 GMT https://www.opsweb.org/forums/posts.aspx?topic=1462805 https://www.opsweb.org/forums/posts.aspx?topic=1462805
In theory, if there was a way to bind the ICG to something else, so it no longer was being collected into the bile it might be possible to reduce ICG reactions even more as a result of spreading it out to more cells.

From the article "Image-Guided Open Cerebrovascular Surgery"

" After intravenous injection, ICG quickly binds to lipoproteins (within 1 to 2 seconds) and remains in the circulation.45–47 ICG is not metabolized in the body and is excreted rapidly and exclusively by the liver into bile.45–47 Its short plasma half-life of 3 to 4 minutes allows repeated intraoperative injections. It is not reabsorbed from the intestine nor does it undergo enterohepatic recirculation.45–47 The recommended dose for ICG video angiography is 0.2 to 0.5 mg/kg; the maximal daily dose should not exceed 5 mg/kg.46"


and also:

"Hepatic Toxicology
G.L. Plaa, in Comprehensive Toxicology, 2010
9.06.3.2 Indocyanine Green Retention
The dye indocyanine green (ICG) was originally introduced into human clinical medicine to measure cardiac output. Subsequently, however, it was observed that about 97% of the intravenously administered dose in dogs was excreted into the bile, while none was found in the urine (Wheeler et al. 1958). Cherrick et al. (1960) reported that ICG was rapidly and completely bound to plasma protein, that it was excreted into the bile in an unaltered form, that extrahepatic removal did not occur, that ICG was nonirritating when administered subcutaneously, and that it produced no untoward reactions upon single or repetitive injections. The substance, therefore, had about the same spectrum of sensitivity and specificity as BSP but offered some more favorable properties than BSP for use in humans."

Both of those are from:
https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/indocyanine-green]]> Fri, 30 Nov 2018 08:15:15 GMT https://www.opsweb.org/forums/posts.aspx?topic=1466094 https://www.opsweb.org/forums/posts.aspx?topic=1466094 Mon, 24 Dec 2018 17:27:19 GMT