𝘍𝘍𝘈 𝘧𝘪𝘯𝘥𝘪𝘯𝘨𝘴 𝘰𝘧 𝘈𝘤𝘶𝘵𝘦 𝘊𝘚𝘊𝘙 𝐈𝐧𝐤 𝐛𝐥𝐨𝐭/ 𝐄𝐱𝐩𝐚𝐧𝐬𝐢𝐥𝐞 𝐃𝐨𝐭 ● 90% ● Small, focal hyperfluorescence leak from choroid through RPE ● Early phase of FFA ● Increases in size and intensity ● Multiple leakage spots can be present 𝐒𝐦𝐨𝐤𝐞𝐬𝐭𝐚𝐜𝐤 ● 10% ● Central spot of hyperfluorescence ● Spreads vertically and laterally in a configuration of a plume of smoke/ mushroom cloud/ umbrella in the late phase ● Due to convection currents and a pressure gradient between increased protein concentration of subretinal fluid and fluorescein dye entering the detachment
𝐃𝐢𝐟𝐟𝐮𝐬𝐞 𝐩𝐚𝐭𝐭𝐞𝐫𝐧 ● Rare ● No obvious leakage points 𝘐𝘊𝘎 𝘧𝘪𝘯𝘥𝘪𝘯𝘨𝘴 𝘰𝘧 𝘈𝘤𝘶𝘵𝘦 𝘊𝘚𝘊𝘙 ● Delay in choroidal filling in early phase with hypofluorescent areas due to non perfusion of choriocapillaries ● Choroidal venous dilatation and choroidal hyperpermeability -- zone of hyperfluorescence in mid phase ● Washout/ persistent hyperfluorescence in late phase 𝘛𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵 𝘐𝘯𝘥𝘪𝘤𝘢𝘵𝘪𝘰𝘯𝘴: ● Persistent serous retinal detachment >3-4 months ● Recurrence in an eye with visual defects from previous CSCR ● Opposite eye with visual defects due to CSCR ● Bilateral CSCR for early rehabilitation ● Occupational need ● Recurrent CSCR with leak located more than than 300 microns from centre of fovea ● Development of chronic signs 𝘖𝘱𝘵𝘪𝘰𝘯𝘴: ● Laser photocoagulation ● Photodynamic therapy ● Medical management: Oral eplerenone ● Anti VEGF therapy in case CNV develops www.ophthalmobytes.com 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 #neurosensorydetachment #inkblot #smokestack