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A. Pryds, B. Sander, M. Larsen; Estimation of Subretinal Leakage Rates in Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1345.
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To estimate the rate of leakage from smokestack type lesions of the retinal pigment epithelium in central serous chorioretinopathy.
Fluorescein angiograms from 13 eyes in 13 patients with a smoke-stack type of dye leakage into the subretinal cavity from a solitary retinal pigment epithelium (RPE) were reviewed and analyzed quantitatively using two different methods to assess the rate of leakage of fluorescein-stained fluid. One method was based on observation of the rate of expansion of the bubble or stained fluid seen in the earliest phase of the angiogram, the other on measuring the area of RPE exposed to subretinal fluid and using a standard value for RPE fluid resorption capacity per unit surface area.
The mean rates of leakage were 16.2 µL/mm2/h (CI95 11.9 to 22.1) with the expanding bubble method and 16.1 µL/mm2/h (CI95 12.0 to 21.7) with the area of resorption method (p = 0.95, linear correlation r = 0.94). The repeatability coefficient for both methods was 36.3 %. Comparison of methods with a Bland-Altman plot showed an even distribution about a horizontal line and a mean ratio of 1.06 (CI95 0.41 to 1.70) (p = 0.52; paired t-test)
The present study demonstrated good overall agreement between two different methods of assessing the rate of smoke-stack leakage in CSC, which was found to occur at rates that are consistent with bulk fluid flow rather than secretion at rates known from secreting or resorbing epithelia. This observation indicates that the primary source of leakage in smoke-stack CSC is not the RPE lesion but a structure posterior to the RPE, quite possibly a hyperpermeable or congested segment of the choroidal vasculature. The overall agreement between the two methods indicates that except for the smoke-stack lesion, the resorption capacity of the RPE is normal.
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