Mixing FA and ICG solutions together - official papers on this? https://www.opsweb.org/forums/posts.aspx?topic=1694750 Sun, 19 Jul 2026 02:08:17 GMT Fri, 27 May 2022 11:03:25 GMT Copyright © 2022 Ophthalmic Photographers' Society Mixing FA and ICG solutions together - official papers on this? https://www.opsweb.org/forums/posts.aspx?topic=1694750 https://www.opsweb.org/forums/posts.aspx?topic=1694750 Hi everyone,

 

At multiple places I've worked, I've been told it's okay to inject the 10% 5mL FA dye directly into our 25mg ICG powder and draw it back for a simultaneous FA/ICG. (or some combination of that, it seems many people have slightly different strategies, but point being FA dye being used to reconstitute ICG in some form). However, we had some nurse educators come in to learn about our process and they are telling us these dyes are not compatible? Does anyone know of any official literature to show her this is a fairly normal and safe thing in ophthalmology? Also, doing a quick forum search I see many people have different strategies for this, what is your clinics way of mixing these dyes, if you choose to do so?

 

Appreciate any help in advance,

Kaitlyn

]]> Tue, 17 May 2022 15:29:03 GMT https://www.opsweb.org/forums/posts.aspx?topic=1694753 https://www.opsweb.org/forums/posts.aspx?topic=1694753
I know that is what Dr. Giovanni Staurenghi does for his combination FA/ICGA. I Went to a Heidelberg conference with him about 10 years ago and he lectured about this and his technique. We usually dilute the ICG and mix it with fluorescein before using in combination. But, I have heard from others that the dues should not be mixed, so I guess I don’t have an answer for you, 😁. ]]> Tue, 17 May 2022 15:39:37 GMT https://www.opsweb.org/forums/posts.aspx?topic=1694757 https://www.opsweb.org/forums/posts.aspx?topic=1694757 Quote:
Originally posted by E. Kegley:
Kaitlyn,

I know that is what Dr. Giovanni Staurenghi does for his combination FA/ICGA. I Went to a Heidelberg conference with him about 10 years ago and he lectured about this and his technique. We usually dilute the ICG and mix it with fluorescein before using in combination. But, I have heard from others that the dues should not be mixed, so I guess I don’t have an answer for you, 😁.

Thanks for the reply! A super quick google search came up with a JAMA article about it and how there were no adverse reactions, but it's almost 25 years old so I don't know if they wouldn't accept it. You'd think there'd be some substantial evidence that it's okay, given there are multiple machines out there that specifically support and suggest doing this technique (both the heidelberg FA/ICG duo filter as well as the Optos Interweaved angiography setting). ]]> Tue, 17 May 2022 15:45:44 GMT https://www.opsweb.org/forums/posts.aspx?topic=1694763 https://www.opsweb.org/forums/posts.aspx?topic=1694763
You will get many views on this. Here's mine.

For FA Dye usage, we only need 2.5 cc of FA dye, and we need to start the timer at the first signs of a push into the vein. [This yields 2 patients per 5 cc bottle of FA Dye]

For ICG Dye usage, we re-constitute 25 mg vial of ICG dye with 9.0 cc of diluent. and mix for 3 mins. Then, we draw up only 3 cc's of that diluted ICG dye [8.33 mg per patient] to deliver into an ICG patient, and push that into the vein and we start the timer for the ICG run. [This yields 3 patients per 9 cc of diluted ICG Dye]

You must have some very quick fingers in order to maintain the time requirements of both FA and ICG start times and Early, Middle, and Late phases of your angiograms.

In addition, if you use the formulary for the ICG above, it extends the usability of 1 vial of ICG dye to three patients, hence a better economic advantage for your practice.

Using your method, you deliver a very concentrated bolus of combined FA/ICG dye, might miss the timing of each, and don't take advantage of spreading out your resources to keep administration and/or purchasing of your practice a little happier on the pocket-book.

Oh, in addition, speaking to an economic perspective vs, a biochemical perspective, did you know that an individual ICG CPT Code for billing yields your practice a larger insurance reimbursement if you do the ICG Dye test separately, vs if you do a combined FA/ICG Dye test together, in your office?

When you get a chance, have your biller check out code 92240 in your area.

Personally, it will increase your 'value as an employee in your office".

Just my 0.2 cents, well more like 2 + 2 or 0.4 cents.

Jim]]> Tue, 17 May 2022 16:04:08 GMT https://www.opsweb.org/forums/posts.aspx?topic=1696052 https://www.opsweb.org/forums/posts.aspx?topic=1696052 Hi Kaitlyn,

I've not heard of diluting the ICG powder with the fluorescein dye before... but do find it an interesting concept! We've been diluting it like most using the sterile water that comes with the package. Pull out 5mls, add to ICG powder, mix, pull out 2.5ml for injection. If simultaneous FA/ICG is requested (which is nearly every time), we add 2.5 of fluorescein dye to the syringe with the ICG dye and go.

As for interactions between the two, I agree with you. With the number of FA/ICG combos being performed, you would think there would be some information available if they were contraindicated as a cocktail. 

Gary

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