Microsoft Word - Shahid Jamal Siddiqui 171 Original Article Pattern of Central Serous Chorioretinopathy (CSCR) on Fundus Fluorescein Angiography Shahid Jamal Siddiqui, Syed Imtiaz Ali Shah, Muhammad Afzal Pechuho , Safdar Ali Abbasi, Fouzia Fateh Shaikh. Pak J Ophthalmol 2008, Vol. 24 No. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . See end of article for authors affiliations … ……………………… Correspondence to: Shahid Jamal Siddiqui Associate Professor of Ophthalmology Banglow # 05 Type II CMC Staff Colony Larkana Purpose: To study the pattern of central serous chorioretinopathy (CSCR) on fundus fluorescein angiography (FFA). Material and Methods: The hospital based descriptive study of 30 patients was conducted at the Department of Ophthalmology Chandka Medical College and Hospital Larkana, from December 2003 to February 2008. The patients were selected from the retina clinic. After history and complete ocular examination the clinical diagnosis of CSCR was established. The fundus photographs and fluorescein angiography was done in all the 30 patients. Before injecting fluorescein, test dose was given and pupils were dilated with tropicamide 1% and phenylepherine 10%. Injection fluorescein sodium 25% 3ml i.e 250 mg/ml was given intravenously and multiple photographs were taken by the digital fundus camera. The patterns of CSCR on fundus fluorescein angiography were observed and notified. Results: In this hospital based descriptive study of 30 patients of CSCR 27 were male (90%) and 03 were female (10%). The patients between 20-55 years of age were presented, with a mean age of 35.4 years. 26 patients had unilateral and 04 with bilateral disease. Number of eyes was 34. All patients presented with blurred vision, positive relative central scotoma and dome shaped elevation at the macula. The duration of visual disturbances on presentation was three days to three months. On fundus fluorescein angiography of 30 patients hyper- 172 Received for publication May’ 2008 … ……………………… fluorescence with ink-blot appearance was seen in 23 eyes (67.64%) and smoke-stack appearance in 11 eyes (30.35%). Conclusion: Ink-blot pattern is more frequently seen in CSCR on fundus fluorescein angiography. entral Serous Chorioretinopathy (CSCR) is characterized by idiopathic serous detach- ment of the sensory retina1. It is an exudative macular disease that predominantly affects young to middle aged men. The characteristic neurosensory detachment on the posterior pole is caused by leakage of fluid seen at the level of retinal pigment epithelium2. Several theories have explained the mechanism and pathogenesis of CSCR. In all of these theories increased choroidal vascular permeability is supposed to be the reason for the serous detachment of the retinal pigment epithelium (RPE)1,3-5. The fundus fluorescein angiography (FFA) findings are very important in the diagnosis of CSCR. In CSCR, there is a breakdown of the outer blood retinal barrier which allows the passage of free fluorescein molecules into the subretinal space6. Various patterns of dye leakage are seen the most common are smoke-stack and ink-blot5. The unusual forms are inverse smoke-stack, diffuse RPE leakage (ooze), RPE atrophic tracts1,7. The objective of this study was to identify and see the various patterns of CSCR on FFA. MATERIAL AND METHODS The hospital based descriptive study of 30 patients was conducted at the Department of Ophthalmology Chandka Medical College and Hospital Larkana. The patients were selected from the retina clinic. After history and complete ocular examination the clinical diagnosis of CSCR was established. The fundus photographs and fluorescein angiography was done in all the 30 patients. A test dose of fluorescein was given and pupils were dilated with topical 1% and phenylepherine 10%. Injection fluorescein sodium 25% 3ml i.e 250 mg/ml was given intravenously and multiple photographs were taken by the digital fundus camera. The patterns of CSCR on fundus fluorescein angiography were observed and recorded. RESULTS In this hospital based descriptive study of 30 patients of CSCR 27 were male (90%) and 03 female (10%). The patients presented were between 20-55 years of age, with a median age of 35.4 years. Twenty six (86.66%) patients had unilateral and 04 (13.33%) were with bilateral disease (Table-1). Number of eyes was 34. All patients presented with blurred vision, positive relative central scotoma and dome shaped elevation at the macula (Figures 1-A, 2-A, 3A). The duration of visual disturbances on presentation was three days to three months. On fundus fluorescein angiography of 30 patients, hyper-fluorescence with ink-blot appearance was seen in 23 eyes (67.64%) (Figure 1-B) and smoke-stack appearance in 11 eyes (30.35%) (Table-2 and Figures 2-B and 2-C). DISCUSSION Fundus fluorescein angiography (FFA) plays a crucial role in the understanding of different disease pro- cesses affecting the eye. A good knowledge of the changes occurring in the fluorescein angiogram is important for correct diagnosis and management of eye disorders. Table 1: Patients Data Total Number of Patients 30 Male 27 (90%) Female 03 (10%) Age (Range) 20-55 years Mean Age 35.4 years C 173 Unilateral 26 (86.66%) Bilateral 04 (13.33%) Table 2: Patterns of CSCR on FFA Fluorescein pattern Number of Eyes (34) n(%) Ink-blot 23 (67.64) Smoke-stack 11(32.35) Our study of 30 cases of rural Sindh population demonstrates that CSCR is more common in males (90%) than females (10%). The patients between 20 – 55 years of age (mean age 35.4 years) were presented Cynthia and colleagues have reported mean age of 55 years (range 35 – 78 years) in their study8. Fundus fluorescein angiography (FFA) in 23 eyes (67.64%) revealed ink-blot appearance and in 11 eyes (32.35%) smoke-stack appearance in our study of 34 eyes with CSCR, which demonstrate that ink-blot appearance is more frequent than smoke-stack appearance. Kanski6 has reported that smoke-stack appearance is more common than ink-blot, whereas other studies by Baig, Peykan and their colleagues have reported ink-blot appearance more commonly seen in CSCR on FFA than smoke-stack appearance1,9. Fig. 1-A: Fundus Photographs showing bilateral CSCR. 174 Fig. 1-B: Fundus fluorescein angiogram shows ink-blot appearance in bilateral CSCR. Fig. 2-A: Fundus photograph of left eye showing dome shaped elevation at the macula. Fig. 2-B: Fundus fluorescein angiogram of left eye showing smoke-stack appearance. Fig. 3-A: Fundus photograph of right eye showing dome shaped elevation at the macula. 175 Fig. 3-B: Fundus fluorescein angiogram of right eye showing smoke-stack appearance. Author’s affiliation Dr: Shahid Jamal Siddiqui Associate Professor Department of Ophthalmology Chandka Medical College & Hospital Larkana Sindh. Prof: Syed Imtiaz Ali Shah Professor & Head Department of Ophthalmology Chandka Medical College & Hospital Larkana Sindh. Dr. Muhammad afzal pechuho Assistant Professor Department of Ophthalmology Chandka Medical College & Hospital Larkana Sindh. Dr. Safdar Ali Abbasi Department of Ophthalmology Chandka Medical College & Hospital Larkana Sindh. Dr. Fouzia Fateh Shaikh Department of Ophthalmology Chandka Medical College & Hospital Larkana Sindh. REFERENCE 1. Peykan T, Turgut Y, Burak T, et al. Unusual Fundus Fluorescein Angiography findings in Central Serous Chorioretinopathy. J of Retina – Vitreous. 2007; 15: 223–5. 2. Michael T, Elzbeita P, Karl K, et al. 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