Pragjyoti Eye Care & Research Centre, 29, Mother Teresa Road, 781 021, Guwahati, Assam, India.
Graefes Arch Clin Exp Ophthalmol. 2010 Mar;248(3):339-51. doi: 10.1007/s00417-009-1212-5. Epub 2009 Oct 15.
To study the demography, various morphological patterns and fluid dynamics of the smokestack leak by fluorescein angiography (FA) in central serous chorioretinopathy (CSC).
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.
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.
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.
通过荧光素血管造影（FA）研究中心性浆液性脉络膜视网膜病变（CSC）中烟囱渗漏的人口统计学、各种形态模式和流体动力学。
第一部分（临床）：回顾 69 例连续 CSC 烟囱渗漏患者的病历和血管造影资料。第二部分（实验）：在一个实验室模型中记录各种浓度的荧光素染料由于对流而移动，该模型大致代表了类似于人眼中 CSC 的封闭室。
临床研究（第一部分）显示，479 例连续病例中有 14.40%有烟囱渗漏，其中 70%发生在首次急性发作（p 值：<0.001），27.14%发生在急性复发性发作（50%为新渗漏），2.85%发生在慢性期。患者主要为男性（84.05%），中位年龄为 34.00 +/- 8.14 岁。排除慢性病例后，中位症状持续时间为 15 +/- 34.28 天。这种类型的渗漏主要见于中型 CSC（48.57%），大多数位于旁中心鼻上象限（31.42%）。上升型渗漏占优势（94.28%）。在四只眼中，观察到一种非典型模式，在两只眼中，同一脱离区域内可见不止一个烟囱渗漏。实验研究（第二部分）表明，含有低浓度荧光素的液体由于对流而上升，而高浓度染料则下降。
临床研究表明，烟囱渗漏在原发性急性发作中更为常见，且通常在疾病急性早期发生（平均持续时间 15 +/- 34.28 天）。很少情况下，这种类型的渗漏也可能发生在慢性期，同一脱离空间内可能会出现多个渗漏。实验模型中由于对流而导致的染料移动的各种模式与本系列中某些 CSC 的染料移动相似。实验研究还暗示了未结合的荧光素分子与富含蛋白质的重液一起沿着渗漏的向下传播而排出的可能性。
