This 44YO male presented with 20/60 vision in his right eye. The left eye was normal with 20/20 vision.
His fluorescein angiogram (FA) shows classic findings for idiopathic central serous chorioretinopathy (ICSC). There is the more common blot leak, as well as the classic “smokestack” leak, which occurs in only about 10% of cases.
The FA also demonstrates the extent of the serous detachment; there is also a tiny RPE detachment without leakage in the distal inferior macula.
The OCT shows both the serous detachment and the small pigment epithelial detachment.
Learning Points:
Fluorescein leaks through a physiologic break in the retinal pigment epithelium (RPE) and rises in the subretinal space, giving the smokestack.
The fluorescein dye then diffuses and pools within the subretinal space, highlighting the extent of the serous detachment.
Most ICSC serous detachments spontaneously resolve within 3 months and do not require treatment. Patients who can’t wait the 3 months (i.e., pilots or surgeons), or those with persistent symptomatic detachments, are best treated with photodynamic therapy.
