Fluorescein Angiography in Pregnancy

I received the following question recently:

“..does anyone know if fluorescein is safe to use during pregnancy?”

The answer is that no one knows. Sodium fluorescein is a chemical dissolved in water that is injected into an arm vein. The photographs are taken using special filters which cause the chemical to absorb light at one wavelength and emit it at another one. The emitted light can be captured digitally or on film. A fluorescein angiogram is a good test to visualize normal and abnormal blood vessels in the eye as well as leakage from these vessels. It’s commonly used in people with AMD, diabetes, or other retinal vascular disease. Fluorescein does cross the placenta.

The only extensive article is referenced below (twice since the same article was published twice). This article resulted from compilation of a questionnaire survey of retinal specialists so it’s difficult to gauge the accuracy of the information. Nevertheless the specialists reported that they had performed an angiogram on a total of 116 pregnant patients. Three of the 116 had nausea during the procedure and an additional 4 had nausea and vomiting. One of the subsequent children was born with an undescended testicle and one had syndactayly (toes or fingers fused together).

Forty one of the 116 women had the angiogram during the first trimester of the pregnancy when there is the most risk of developmental malformations. Four fetal deaths occurred in these 41 women. Two were thought to be due to complications of severe eclampsia and not the fluorescein; one occurred months after the fluorescein angiogram; and one occurred three days after the fluorescein in a healthy woman who had been four weeks pregnant. The authors concluded that fluorescein angiography was safe in pregnancy because fetal deaths are not uncommon in severe eclampsia and there were only two mild malformations. Greenberg and Lewis later criticized the article stating that no firm conclusions could be reached from such a study.

Most retinal experts don’t perform fluorescein angiography on pregnant women. Almost always the diagnosis can be made from the clinical exam, plain color photography, and optic coherence tomography none of which involve any drug. The risk of congenital malformations or spontaneous abortions is probably low with fluorescein angiography but no one can say that it’s completely safe.

References

1. Halperin LS, Olk RJ, Soubrane G, Coscas G. Safety of fluorescein angiography during pregnancy. Am J Ophthalmol. 1990 May 15;109(5):563-6.
2. Olk RJ, Halperin LS, Soubrane G, Coscas G. Fluorescein angiography--is it safe to use in a pregnant patient? Eur J Ophthalmol. 1991 Apr-Jun;1(2):103-6.
3. Greenberg F, Lewis RA. Safety of fluorescein angiography during pregnancy. Am J Ophthalmol. 1990 Sep 15;110(3):323-5.