Ink and Smoke!

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#cscr #neurosensorydetachment#neurosensorydetachment #inkblot#inkblot #smokestack#smokestack

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