Smokestack leak in central serous chorioretinopathy

Abstract

The clinical study revealed smokestack leaks to be significantly more common in a primary acute episode, and they usually develop in the early part of the acute phase of the disease (average duration 15 +/- 34.28 days). Rarely, this type of leak can occur in the chronic stage, and multiple leaks may develop in the same detached space. The various patterns of dye movement due to convection currents in the experimental model resembled the dye movement in certain cases of CSC of the present series. The experimental study also hinted at the probability of drainage of unbound fluorescein molecules along with protein-laden heavy fluid in downward spread of the leak.

Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis

“…They can also follow two classical patterns: the "ink-blot" pattern, with a progressive expansion of a circular hyperfluorescence arising from a central pinpoint, or the "smokestack" pattern, in which the hyperfluorescence ascends with a slight lateral diffusion producing a mushroom-like image above the leaking point. In a study of 479 acute, recurrent and chronic cases, a smokestack leak was observed in 14% of subjects, and was predominantly associated with acute early forms, with a mean of 15 days since onset of symptoms (Bujarborua et al, 2010).…”

Retinal and choroidal changes observed with ‘En face’ enhanced-depth imaging OCT in central serous chorioretinopathy

“…Patients with CSC develop one or more serous retinal pigment epithelium (RPE) detachment (PED) in or around the macular area, which may lead to serous retinal detachment (SRD) 1 2. Leakage points are clearly seen during fluorescein angiography (FA) showing a focal leak at the level of the RPE and gradually expanding into the shape of a smokestack or an inkblot pattern 3. Generally, retinal detachments resulting from acute CSC resolve spontaneously within a few months1 and the patient's visual acuity returns to normal without any treatment.…”

Stellungnahme des Berufsverbandes der Augenärzte Deutschlands, der Deutschen Ophthalmologischen Gesellschaft und der Retinologischen Gesellschaft zur Chorioretinopathia centralis serosa (CCS)

“…Patienten mit akuter CCS weisen in der Frühphase fokale Hyperfluoreszenzareale auf, die in der Folge zirkulär expandieren (sogenannte Tintenfleckmuster) oder sich in ca. 15 % vertikal und horizontal ausbreiten können, was als sogenanntes Schornsteinphänomen bezeichnet wird [10]. In chronischen Verlaufsformen weist die Fluoreszenzangiografie granuläre Hyperfluoreszenzareale mit nur geringer und langsam zunehmender Leckage auf [93].…”