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Central serous chorioretinopathy (CSC) is characterized by detachment of the neurosensory retina, often with PED. In acute CSC, FA may identify the source of focal leakage in the form of “smokestack” or “inkblot” appearance (Fig. 24). Pooling from associated PEDs may also be seen. Focal laser to these leakage points, if located extrafoveally, may hasten the resolution of the neurosensory detachment. Where leakage areas are extensive, photodynamic therapy may be preferred. In chronic or recurrent CSC, FA, together with fundus autofluorescence, can also demonstrate the extent of RPE damage which appears as a window defect. These areas may appear as a “downward gravitational track” in chronic cases (Fig. 25). This information is important in prognosticating visual outcome. Choroidal vascular hyperpermeability is often noted in CSC and is best visualized with ICGA. Large choroidal vessels can appear congested, and leakage through the choriocapillaris and choroidal vessels results in a fuzzy appearance in late phases of ICGA (Fig. 24). Reduced-fluence photodynamic therapy covering the entire area of choroidal vascular hyperpermeability has been suggested to reduce the recurrence rate of CSC.

Fig. 21. Coat's disease. On color photograph (a), a large plaque made up of hard exudates can be seen in the macula. On the fluorescein angiogram (b, d), telangiectatic vessels and peripheral nonperfusion can be seen in the temporal retina. The aneurysmal dilatations are clearly seen on the indocyanine green angiogram (c).

Fig. 22. Eales' disease. On the widefield fluorescein angiogram (a), preretinal hemorrhage can be seen along the inferotemporal arcade. An area of neovascularization with intense leakage can be seen in the periphery. Details of neovascularization can be seen on images with higher magnification (b, c).

Fig. 23. Radiation retinopathy. Many features of radiation retinopathy are similar to changes in diabetic retinopathy. On this fluorescein angiogram of a patient who had previously undergone radiation for nasopharyngeal carcinoma, microaneurysms can be seen in the nasal retina (a) and enlargement of the foveal avascular zone in the posterior pole (b). Leakage indicating macular edema can be seen on the late-phase image (c).

Fig. 24. Acute central serous chorioretinopathy (CSC). Typical appearance of fluorescein angiogram in acute CSC is focal leak at the level of the retinal pigment epithelium in the form of smokestack (a) or inkblot (b) pattern. Choroidal hyperpermeability is often present and is best seen on indocyanine angiogram (c).

Fig. 25. Chronic central serous chorioretinopathy. Extensive mottling of the retinal pigment epithelium in the pattern of a “downward track” can be seen on the color photograph (arrow; a). This area appears as irregular window defects on the fluorescein angiogram (b). In addition, some areas of pinpoint leakage are still visible (c).

Fig. 26. Multiple evancescent white dot syndrome. This 28-year-old lady had a history of recent-onset central scotoma with photopsia. The appearance of the posterior pole was unremarkable (a). Disc hyperfluorescence is seen on late-phase fluorescein angiogram (b). Multiple hypofluorescent spots are seen on the indocyanine green angiogram (c).

Fig. 27. Vogt-Koyanagi-Harada disease. Typical features include multiple neurosensory detachments affecting both eyes (a). On fluorescein angiogram, pinpoint hyperfluorescent dots at the level of the retinal pigment epithelium are visible in the early phase which continue to leak and eventually pool into areas of serous detachment (b). On indocyanine green angiogram (c), multiple hypofluorescent dark dots can be seen which are believed to represent choroidal nonperfusion. In addition, fuzziness of the large choroidal vessels can be seen.

Fig. 28. Behçet's disease. The ultrawide-field color photograph is hazy due to vitritis. However, sheathing of peripheral vessels and small areas of retinitis can be seen (a). Fluorescein angiogram (b) shows extensive peripheral retinal vascular leakage and disc hyperfluorescence.

Fig. 29. Punctate inner choroidopathy complicated by secondary choroidal neovascularization (CNV). Multiple punctate lesions can be seen on the color fundus photograph (a). These lesions appear as window defects but do not leak on the fluorescein angiogram (b, c). In contrast, profuse leakage can be seen from a secondary active CNV (arrow).