Ink & Smoke
๐๐๐ ๐ง๐ช๐ฏ๐ฅ๐ช๐ฏ๐จ๐ด ๐ฐ๐ง ๐๐ค๐ถ๐ต๐ฆ ๐๐๐๐โฃ โฃ
๐๐ง๐ค ๐๐ฅ๐จ๐ญ/ ๐๐ฑ๐ฉ๐๐ง๐ฌ๐ข๐ฅ๐ ๐๐จ๐ญโฃ โฃ
โ 90%โฃ โ Small, focal hyperfluorescence leak from choroid through RPEโฃ
โ Early phase of FFAโฃ
โ Increases in size and intensityโฃ
โ Multiple leakage spots can be presentโฃ โฃ
๐๐ฆ๐จ๐ค๐๐ฌ๐ญ๐๐๐คโฃ โฃ
โ 10%โฃ
โ Central spot of hyperfluorescenceโฃ
โ Spreads vertically and laterally in a configuration of a plume of smoke/ mushroomโฃ cloud/ umbrella in the late phaseโฃ
โ Due to convection currents and a pressure gradient between increased proteinโฃ concentration of subretinal fluid and fluorescein dye entering the detachmentโฃ
๐๐ข๐๐๐ฎ๐ฌ๐ ๐ฉ๐๐ญ๐ญ๐๐ซ๐งโฃ โฃ
โ Rareโฃ
โ No obvious leakage pointsโฃ โฃ
๐๐๐ ๐ง๐ช๐ฏ๐ฅ๐ช๐ฏ๐จ๐ด ๐ฐ๐ง ๐๐ค๐ถ๐ต๐ฆ ๐๐๐๐โฃ โฃ
โ Delay in choroidal filling in early phase with hypofluorescent areas due to non perfusion of choriocapillariesโฃ
โ Choroidal venous dilatation and choroidal hyperpermeability -- zone of hyperfluorescence in mid phaseโฃ
โ Washout/ persistent hyperfluorescence in late phaseโฃ โฃ
๐๐ณ๐ฆ๐ข๐ต๐ฎ๐ฆ๐ฏ๐ต ๐๐ฏ๐ฅ๐ช๐ค๐ข๐ต๐ช๐ฐ๐ฏ๐ด:โฃ โฃ
โ Persistent serous retinal detachment >3-4 monthsโฃ
โ Recurrence in an eye with visual defects from previous CSCRโฃ
โ Opposite eye with visual defects due to CSCRโฃ
โ Bilateral CSCR for early rehabilitationโฃ
โ Occupational needโฃ
โ Recurrent CSCR with leak located more than than 300 microns from centre of foveaโฃ
โ Development of chronic signsโฃ โฃ
๐๐ฑ๐ต๐ช๐ฐ๐ฏ๐ด:โฃ
โ Laser photocoagulationโฃ
โ Photodynamic therapyโฃ
โ Medical management: Oral eplerenoneโฃ
โ Anti VEGF therapy in case CNV developsโฃ
โฃ www.ophthalmobytes.comโฃ โฃ
Image from Rajan Eye Care Hospital
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