This 37YO male presented with one month of decreased vision in his left eye. There was no history of steroid or testosterone use. Vision was 20/20 in his normal OD and 20/40 OS.
MultiColor SLO imaging shows a large macular serous detachment extending into the inferior midperiphery, associated with fibrinous subretinal fluid. A horizontal OCT B-scan shows hyperreflective subretinal fibrin with a round hyporeflective lesion. A vertical B-scan shows the serous detachment extending inferiorly. Fluorescein angiography shows a smokestack leak.
Learning Points:
In idiopathic central serous chorioretinopathy (ICSC), fluorescein dye diffuses through a physiological break in the RPE and then pools within the subretinal space. The clearing within our patient’s inferotemporal subretinal fibrin (as evidenced by the hyporeflective round lesion on OCT) is likely caused by serous fluid entering the subretinal space and ‘washing away’ some of the fibrin.
Most patients with ICSC have a single, unilateral leak. Blot leaks are most common, with only 10% of cases exhibiting a smokestack. The subretinal fibrin noted in our patient is more commonly found in steroid-induced disease, although our patient denied steroid exposure.
