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Ink and Smoke!

๐˜๐˜๐˜ˆ ๐˜ง๐˜ช๐˜ฏ๐˜ฅ๐˜ช๐˜ฏ๐˜จ๐˜ด ๐˜ฐ๐˜ง ๐˜ˆ๐˜ค๐˜ถ๐˜ต๐˜ฆ ๐˜Š๐˜š๐˜Š๐˜™โฃ โฃ ๐ˆ๐ง๐ค ๐›๐ฅ๐จ๐ญ/ ๐„๐ฑ๐ฉ๐š๐ง๐ฌ๐ข๐ฅ๐ž ๐ƒ๐จ๐ญโฃ โฃ โ— 90%โฃ โ— Small, focal hyperfluorescence leak from choroid through RPEโฃ โ— Early phase of FFAโฃ โ— Increases in size and intensityโฃ โ— Multiple leakage spots can be presentโฃ โฃ ๐’๐ฆ๐จ๐ค๐ž๐ฌ๐ญ๐š๐œ๐คโฃ โฃ โ— 10%โฃ โ— Central spot of hyperfluorescenceโฃ โ— Spreads vertically and laterally in a configuration of a plume of smoke/ mushroomโฃ cloud/ umbrella in the late phaseโฃ โ— Due to convection currents and a pressure gradient between increased proteinโฃ concentration of subretinal fluid and fluorescein dye entering the detachmentโฃ



โฃ ๐ƒ๐ข๐Ÿ๐Ÿ๐ฎ๐ฌ๐ž ๐ฉ๐š๐ญ๐ญ๐ž๐ซ๐งโฃ โฃ โ— Rareโฃ โ— No obvious leakage pointsโฃ โฃ ๐˜๐˜Š๐˜Ž ๐˜ง๐˜ช๐˜ฏ๐˜ฅ๐˜ช๐˜ฏ๐˜จ๐˜ด ๐˜ฐ๐˜ง ๐˜ˆ๐˜ค๐˜ถ๐˜ต๐˜ฆ ๐˜Š๐˜š๐˜Š๐˜™โฃ โฃ โ— Delay in choroidal filling in early phase with hypofluorescent areas due to non perfusion of choriocapillariesโฃ โ— Choroidal venous dilatation and choroidal hyperpermeability -- zone of hyperfluorescence in mid phaseโฃ โ— Washout/ persistent hyperfluorescence in late phaseโฃ โฃ ๐˜›๐˜ณ๐˜ฆ๐˜ข๐˜ต๐˜ฎ๐˜ฆ๐˜ฏ๐˜ต ๐˜๐˜ฏ๐˜ฅ๐˜ช๐˜ค๐˜ข๐˜ต๐˜ช๐˜ฐ๐˜ฏ๐˜ด:โฃ โฃ โ— Persistent serous retinal detachment >3-4 monthsโฃ โ— Recurrence in an eye with visual defects from previous CSCRโฃ โ— Opposite eye with visual defects due to CSCRโฃ โ— Bilateral CSCR for early rehabilitationโฃ โ— Occupational needโฃ โ— Recurrent CSCR with leak located more than than 300 microns from centre of foveaโฃ โ— Development of chronic signsโฃ โฃ ๐˜–๐˜ฑ๐˜ต๐˜ช๐˜ฐ๐˜ฏ๐˜ด:โฃ โ— Laser photocoagulationโฃ โ— Photodynamic therapyโฃ โ— Medical management: Oral eplerenoneโฃ โ— Anti VEGF therapy in case CNV developsโฃ โฃ www.ophthalmobytes.comโฃ โฃ Image from Rajan Eye Care Hospital #ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency #retina #macula #centralserouschorioretinopathy #cscr#cscr #neurosensorydetachment#neurosensorydetachment #inkblot#inkblot #smokestack#smokestack

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