Oral fluorescein angiography in pediatric ophthalmology

Abstract

We evaluate the administration protocols, diagnostic utility, and safety of oral fluorescein angiography (OFA) in pediatric ophthalmological diseases, with a secondary objective of comparing OFA to intravenous fluorescein angiography (IVFA) in terms of image quality and clinical utility. A comprehensive search of PubMed, Embase, and Web of Science was conducted, focusing on studies involving pediatric patients. Fifteen studies were included, with 11 assessing the utility and safety of OFA and 4 comparing it to IVFA. These studies covered 581 eyes from 464 patients. The most common dosing protocol for OFA involved 25 mg/kg of 10 % fluorescein dye, with various dilution solutions and fasting requirements enhancing image quality. Adverse effects were minimal, with mild reactions such as itching or nausea observed in 0.019 % of patients. OFA demonstrated good diagnostic value across various pathologies, including retinal vasculopathies, uveitis, disc edema, and Coats disease. OFA is a feasible imaging modality that is a less invasive and better-tolerated alternative to IVFA in the pediatric population, providing high-quality diagnostic images with fewer adverse effects. Our review highlights the need for standardized administration protocols and further research into optimizing dosing and ingestion techniques to enhance image quality and diagnostic utility.

Keywords: Fluorescein angiography; Oral fluorescein; Pediatric retinal disease; Sickle cell retinopathy; Ultrawide-field fluorescein angiography; Uveitis.