This patient has a large serous retinal detachment from idiopathic central serous chororetinopathy (ICSC).
OCT demonstrates the serous retinal detachment and a pigment epithelial detachment.
The late phase fluorescein angiography hows classic “smokestack” leakage.
Learning Points:
ICSC is part of a larger spectrum of pachychoroid diseases. Pachychoroid, meaning “thick” choroid, is secondary to large dilated Haller vessels.
Increased hydrostatic pressure from these dilated vessels can lead to RPE dysfunction, causing serous detachments and macular neovascularization.
The “smokestack” leakage pattern on fluorescen angiography is actually seen in only 10% of eyes with active ICSC.
Some cases resolve on their own, but in chronic cases, photodynamic therapy (PDT) is the gold standard for treatment.
