Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 9290
  • Home
  • Print this page
  • Email this page

   Table of Contents      
COMMENTARY
Year : 2018  |  Volume : 66  |  Issue : 8  |  Page : 1183

Commentary: Smoke stack leak on indocyanine green angiography in acute central serous chorioretinopathy


Department of Vitreo-Retinal Services, Aravind Eye Hospital, Anna Nagar, Madurai, Tamil Nadu, India

Date of Web Publication23-Jul-2018

Correspondence Address:
Dr. Chitaranjan Mishra
Department of Vitreo-Retinal Services, Aravind Eye Hospital, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_606_18

Rights and Permissions

How to cite this article:
Mishra C. Commentary: Smoke stack leak on indocyanine green angiography in acute central serous chorioretinopathy. Indian J Ophthalmol 2018;66:1183

How to cite this URL:
Mishra C. Commentary: Smoke stack leak on indocyanine green angiography in acute central serous chorioretinopathy. Indian J Ophthalmol [serial online] 2018 [cited 2020 May 26];66:1183. Available from: http://www.ijo.in/text.asp?2018/66/8/1183/237344



The pathophysiology of central serous chorioretinopathy (CSCR) involves multiple mechanisms that ultimately lead to widespread choroidal circulatory abnormalities and subsequent retinal pigment epithelial (RPE) disturbances. Angiography of retinochoroidal vascular system is very important in the diagnosis and management of CSCR.

Smoke stack leakage (SSL) is an important finding in fluorescein angiography (FA) of CSCR cases, the mechanism of which can be explained by an increased concentration of protein in the subretinal fluid. However, indocyanin green angiography (ICGA) does not typically show SSL in acute CSCR.

The work by Ayachit et al.[1] is appreciated for the documentation of a rare finding, i.e., SSL in ICGA in acute CSCR cases. The explanations for the finding given by them, e.g., possible presence of an RPE microrip or vigorous leakage from choriocapillaris is well taken and supported by literature. The phenomena of RPE microrip or RPE blow out was explained by Goldstein et al.[2]

However, it is noteworthy that this is not the first report of its kind as claimed by the authors. Piccolino et al. has demonstrated the smoke stack appearance in ICGA in acute CSCR.[3]

Spectral domain OCT imaging helps to identify RPE microrip. There have been mentions about other possible mechanisms for hyperpermeability and leakage in chronic CSCR in recent literature, some of which can be pondered in cases of CSCR who are presenting early. Prakash et al. has mentioned about occult PEDs.[4] Teussink et al. have mentioned about the role of reduced blood perfusion and ischemia in the choriocapilaries, demonstrated in OCTA, which may be surrounded by reactive hyperperfusion which leads to increased hydrostatic pressure within the fenestrated choriocapillaris.[5] This along with chronic hypoxic damage may lead to disintegrity in the continuity of RPE leading to leakage of subretinal fluid. There has been mention about RPE degeneration by Hyashi et al.[6] Hypoperfusion and vasodilation of choriocapillaries has been mentioned by Gajdecka et al.[7] There are recent publications regarding choroidal vascularity index in CSCR, which may throw some light on the exact mechanism of this rare finding.[8]

Finally, SSL in ICGA in acute CSCR is a rare finding and its documentation and discussion about possible mechanisms among peer group enriches the collective academical knowledge.



 
  References Top

1.
Ayachit A, Kumar V, Raj N, Ayachit G. Smokestack leak on indocyanine green angiography in acute central serous chorioretinopathy. Indian J Ophthalmol 2018;66:1181-2.  Back to cited text no. 1
  [Full text]  
2.
Goldstein BG, Pavan PR. 'Blow-outs' in the retinal pigment epithelium. Br J Ophthalmol. 1987;71:676-81. Erratum in: Br J Ophthalmol 1988;72:240.  Back to cited text no. 2
    
3.
Piccolino FC, Borgia L, Zinicola E, Zingirian M. Indocyanine green angiographic findings in central serous chorioretinopathy. Eye (Lond) 1995;9:324-32.  Back to cited text no. 3
    
4.
Prakash G, Chauhan N, Jain S, Satsangi SK. Central Serous Chorioretinopathy: A Review of the Literature. Asia Pac J Ophthalmol (Phila) 2013;2:104-10.  Back to cited text no. 4
    
5.
Teussink MM, Breukink MB, van Grinsven MJ, Hoyng CB, Klevering BJ, Boon CJ, et al. OCT Angiography Compared to Fluorescein and Indocyanine Green Angiography in Chronic Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2015;56:5229-37.  Back to cited text no. 5
    
6.
Hayashi K, Hasegawa Y, Tokoro T. Indocyanine green angiography of central serous chorioretinopathy. Int Ophthalmol 1986;9:37-41.  Back to cited text no. 6
    
7.
Gajdzik-Gajdecka U, Dorecka M, Nita E, Michalska A, Miniewicz-Kurowska J, Romaniuk W. Indocyanine green angiography in chronic central serous chorioretinopathy. Med Sci Monit 2012;18:CR51-7.  Back to cited text no. 7
    
8.
Agrawal R, Chhablani J, Tan KA, Shah S, Sarvaiya C, Banker A. Choroidal vascularity index in central serious chorioretinopathy. Retina 2016;36:1646-51.  Back to cited text no. 8
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed662    
    Printed0    
    Emailed0    
    PDF Downloaded118    
    Comments [Add]    

Recommend this journal