Purpose

Fluorescein angiography (FA) is a vital tool for evaluating patients with posterior uveitis. Known risk of severe anaphylaxis range from 1 in 40,000 to 1 in 200,000. To identify local incidence of severe adverse events to FA, risk factors and complications

Methods

10-years review of all patients who had FA within the eye units at University Hospitals Birmingham (UHB: Queen Elizabeth Hospital [QEH], Good Hope [GH], Solihull [SH] and Heartlands [HGS]) from 1st May 2011 to 30th April 2021, in the UK. Data retrieval was done by Health Informatics and Medisoft®. Data analysis and comparative review was performed against published data (Kornblau IS 2019) with focus on patients requiring hospital admission within 48 hours of FA. Causes for re-admission, specific adverse reactions to FA as well as comorbidity data were assessed

Results

3,223 cases had FA. Patient ages ranged from 15 to 99years. Average age 66.9years. Equal ratio of males and females had FA. 14 cases (0.4%) required re-admission with 48 hours of FA. Age range: 61 to 92years. Mean age: 78years. Gender evaluation: males 9 versus 5 females. A 78years old male with prior uneventful FA in 2008, on ß-blockers died within 3 hours of undergoing FA in 2015. Root cause analysis (RCA) revealed a paradoxical inhibitory epinephrine response to anaphylaxis treatment.

Conclusions

To improve patient safety, we: • updated our informed consent process by stratifying contraindications to FA into absolute (severe allergies, MI/CVA within 3 months) and relative (prior seizures and beta-blocker use). • advocate close monitoring of Sats, BP and HR during FA. • Aim to raise clinician awareness of increased risk of severe and resistant anaphylactic shock and the need for aggressive and prolonged support in patients on ß-blocker therapy.