Dear Cyndy,

At about 11 a.m. I placed a call to my brother-in-law
Peter McPhedran who is a hematologist at Yale, to ask his
advice about the (presumably very small) risk of precipitating
an episode of Henoch Schoenlein Purpura with a repeat infusion
of fluorescein for angiography. I left a message on his answering
machine and he will probably return my call before the weekend
is over. I will telephone my retina consultant Peter Lou on Monday.

Meanwhile I've been chatting with Klemens who as you may or may
not know is a professor of medicine at Tufts, and who is sitting
on the porch next to me scanning into his laptop computer ancient
family photographs recently mailed to me by my cousin Marion. 
Klemens and I agree that the diagnostic value of fluorescein
angiography in identifying potentially treatable Henoch Schoenlein
vasculitis of the retina far outweighs the miniscule risk of
fluorescein's precipitating another attack of purpura. Our reasoning
from what Klemens calls "the marketplace of publication" is that
fluorescein angiography has been performed millions of times,
and if it precipitated purpura, one would be able to find at least
one case report: - I have found none. One also has the option of
24 hrs.' prophylactic administration of high doses of oral corticosteroid,
(prednisone 40 mg) to diminish the admittedly very small risk of
fluorescein induced purpura. The risk of one day's administration
of prednisone is also very small; but having specified the option
of prednisone prophylaxis, my intuition is not to avail myself of it.

My respectful suggestion is: a) to permit the fluorescein angiography
to be performed, b) not to permit either laser treatment or injection
until the fluorescein angiograms have been independently reviewed, and 
c) to obtain one copy of the fluorescein angiogram of 18 months ago,
d) to obtain one copy of the current fluorescein angiogram, "because
my daughter Victoria who is a physician would like to see them."
e) then to pay a commercial photographic laboratory to make at least
three copies of the old and three copies of the new angiogram.
f) to prepare a covering letter (which I will help you draft)
containing a medical history and a request for diagnostic and
therapeutic advice, to be submitted with the angiograms
to one or more consultant retinal surgeons. I have mentioned
Peter L. Lou MD., 10 Hawthorne Place Suite 106., Boston MA, 02114-2336.
(617) 523-0955. but I see no harm in obtaining a third or even a fourth
opinion. You should not procrastinate, but neither should you be stampeded
into a decision; you should meditate on the opinions as you receive them,
then decide on the treatment, if any, that seems best to you.
Jochen

P.S. Unless there is in the RIGHT eye a critically narrow anterior
chamber angle making dilation dangerous, the RIGHT eye should be
dilated concurrently with the left, and the intravenous fluorescein
injection utilized to obtain also an angiogram of the RIGHT eye,
as a baseline reference which we hope will never be needed.

If you have further questions, please don't hesitate to telephone.