This 61YO male presented with classic findings for idiopathic central serous chorioretinopathy (ICSC). There is a large serous macular detachment that is diffusely hyperautofluorescent.
Fluorescein angiography shows a small dot of early hyperfluorescence with a late smokestack leak.
Triton swept-source OCT shows the serous detachment with a small underlying RPE detachment near the area of angiographic leakage.
Learning Points:
‘Smokestack’ leakage, which only occurs in about 10% of active ICSC cases, is due to a physiologic break in the retinal pigment epithelium (RPE), allowing the fluorescein to leak through the RPE and rise into the subretinal space.
Most ICSC serous detachments spontaneously resolve within 3 months and do not require treatment. Patients who can’t wait 3 months (e.g., pilots or retinal surgeons) or those with persistent symptomatic detachments are best treated with photodynamic therapy.
