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Smokestack leak in central serous chorioretinopathy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To study the demography, various morphological patterns and fluid dynamics of the smokestack leak by fluorescein angiography (FA) in central serous chorioretinopathy (CSC).

Methods

Part I (clinical): review of the medical records and angiographic documents of 69 consecutive cases of CSC with smokestack leak. Part II (experimental): documentation of the movement of various concentrations of fluorescein dye due to convection currents in a laboratory model that roughly represents a closed chamber similar to that of CSC in human eyes.

Results

The clinical study (Part I) revealed that 14.40% of 479 consecutive cases had smokestack leak, of which 70% occurred in first acute episode (p-value: <0.001), 27.14% in acute recurrent episodes (50% fresh leak) and 2.85% in chronic stage. Patients were predominantly male (84.05%) with a median age of 34.00 ± 8.14 years. The median symptom duration excluding the chronic cases was 15 ± 34.28 days. This type of leak was mostly (48.57%) seen in medium-sized CSC, and the majority were in the parafoveal superonasal quadrant (31.42%). The ascending type of leak was predominant (94.28%). In four eyes, an atypical pattern and in two eyes more than one smokestack leak were seen within the same detached area. The experimental study (Part II) demonstrated that fluid containing a low concentration of fluorescein ascended due to convection currents, whereas highly concentrated dye descended.

Conclusions

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.

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Acknowledgements

We are grateful to Dr Nazimul Hussain, Dr Samrat Chatterjee, Dr Wartikar Sharang, Dr Geetanjali Bori, Dr Ankur Rahman, Dr. Aditya Sharma and Dr Kamal Nagpal for their help in various stages of this study, and indebted to Mr Omana Kuttan for his technical assistance.

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Authors and Affiliations

  1. Pragjyoti Eye Care & Research Centre, 29, Mother Teresa Road, 781 021, Guwahati, Assam, India

    Dhiren Bujarborua

  2. Retina Foundation, Ahmedabad, Gujrat, India

    Pran N. Nagpal

  3. Department of Statistics, Arya Vidyapeeth College, Guwahati, Assam, India

    Manab Deka

Authors
  1. Dhiren Bujarborua
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  2. Pran N. Nagpal
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  3. Manab Deka
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Correspondence to Dhiren Bujarborua.

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Bujarborua, D., Nagpal, P.N. & Deka, M. Smokestack leak in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 248, 339–351 (2010). https://doi.org/10.1007/s00417-009-1212-5

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  • DOI: https://doi.org/10.1007/s00417-009-1212-5

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