Ink & 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
Image from Rajan Eye Care Hospital
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