Fundus Fluorescein Angiograms Research Articles

When Retinal Vasculitis Wears a Mask: Unveiling Retinal Vasculitis Presented as Branch Retinal Vein Occlusion in a Young Male Patient

Introduction : Retinal vasculitis can present with a range of clinical features. Correct diagnosis and prompt treatment are essential to prevent permanent visual loss. We describe a case of retinal vasculitis with branch retinal vein occlusion (BRVO) as initial diagnosis, which is a rare manifestation in a young individual without any vascular risk factors.
 Case Illustration : A 24-year-old male was referred to our center with a sudden onset of blurry vision of his left eye. He was previously diagnosed with BRVO. The patient denied having any chronic diseases, fever, or sore throat. Visual acuity was 6/18 on the left eye and 6/6 on the right eye, respectively. The anterior segment showed no abnormalities. However, fundus examination revealed prominent retinal sheathing, retinal whitening at the inferior quadrant, and macular star. Systemic diseases, such as Bechet disease, sarcoidosis, and systemic lupus erythematosus were excluded by ancillary tests. One month after the initial examination, the patient reported worsening of vision. Funduscopic examination revealed preretinal hemorrhages and macular star. The patient then received intravitreal injection of anti-vascular endothelial growth factor (VEGF), which helped to resolve the hemorrhage and improve vision.
 Discussion : Further investigations, such as fundus fluorescein angiogram, may aid in the diagnosis and management of this condition. Anti-VEGF therapy may be a useful treatment option for retinal vasculitis-associated hemorrhages.
 Conclusion : Our case highlights the importance of considering retinal vasculitis as a differential diagnosis in young patients presenting with BRVO, even in the absence of traditional risk factors.

AI in ophthalmology: From invisible to visible

The emergence of artificial intelligence offers great potential to revolutionize practice pattern in highly image driven specialties of medicine, including Ophthalmology. In the 2 years, our research team has been collecting pairwise images, such as full colour fundus photograph (FCFP) and fundus fluorescein angiogram (FFA), on the same patients. Based on these images and Generative Adversarial Network (GAN), we developed algorithm that can “generate” FFA‐style of images based on traditional FCFP. With this technology, we can “visualize” the microaneurysm, retinal ischemia, retinal neovascularization from FCFP much better than ever before. In this lecture, we will summarize the progression on this “generative AI” work including the accuracy, challenges and opportunities.

Gradeability and Reproducibility of Geographic Atrophy Measurement in GATHER-1, a Phase II/III Randomized Interventional Trial

To validate GATHER-1 inclusion criteria and the study's primary anatomic end point by assessing the reproducibility of geographic atrophy (GA) measurements and factors that affect reproducibility. Post hoc analysis of phase II/III clinical trial. All 286 participants included in the GATHER-1 study. For each subject, blue-light fundus autofluorescence (FAF), color fundus photographs, fluorescein angiograms, and OCT scans were obtained on the study eye and fellow eye. Geographic atrophy area and other lesion characteristics were independently graded by 2 experienced primary readers. If the 2 readers differed on gradeability, GA area (> 10%) or other lesion characteristics, the image was graded by an arbitrator whose measurement or characterization was the final grade. The main outcome measures were gradeability and reproducibility of FAF imaging data. Imaging data included lesion area, confluence of GA with peripapillary atrophy (PPA), whether GA involved the foveal centerpoint, and type of hyperautofluorescence pattern. A total of 2004 images (1002 visits, 286 participants) were analyzed. Gradeability (90.5%) and interreader gradeability concordance (90.2%) were high across all visits. Study eye images were more gradable compared with fellow-eye images. A greater proportion of smaller lesions required arbitration, but interreader reproducibility was consistently high for all images. There was no difference in gradeability, gradeability concordance, or lesion-area concordance for images with PPA-confluent GA compared with those with nonconfluent PPA. Foveal centerpoint-involving lesions had lower gradeability and lesion-area concordance. Images with diffuse patterns of hyperautofluorescence had better gradeability and gradeability concordance than those with nondiffuse patterns but had no difference in lesion-area or lesion-area concordance. There is high gradeability and excellent reproducibility measures across all images. These data support the validity of conclusions from GATHER-1 and the chosen inclusion criteria and end point. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A pilot study of diabetic retinopathy in a porcine model of maturity onset diabetes of the young type 3 (MODY3)

Diabetic retinopathy (DR) is a leading cause of blindness in the working population. Because novel therapeutic intervention require testing, there is an urgent need for reliable animal models that faithfully replicate DR. Pig eyes have many similarities to human eyes anatomically and physiologically. Thus, attempts have been made to establish porcine models of DR by surgical, pharmaceutical or genetical induction of insulin deficiency, and dietary intervention. A previous study reported a transgenic pig model of maturity onset diabetes of the young type 3 (MODY3) developed signs of severe DR such as hemorrhage and proliferative tissue at the surface of the retina. However, the course of development of DR has not been studied in detail in this model. The purpose of this study was to investigate the early phase of DR in a MODY3. MODY3 and wild-type (WT) pigs underwent fundus photography and fluorescein angiogram (FA) before they developed cataracts. Animals were euthanized at age 1, 4, 7, and 10 months. Whole-mount retina and 10-μm thick paraffinized sections were stained with isolectin B4, and vessel density was determined by MATLAB software. At 4 and 7 months, retinal arterioles were immediately cannulated, and vasomotor action was measured by incubation with bradykinin and sodium nitroprusside. In the MODY3 pigs, fasting blood sugar levels gradually increased up to 500 mg/dL. Vascular tortuosity and yellowish spindle-shaped lesions were confirmed in MODY3 pigs at the age of 7 months; however, no microaneurysms were detected on FA. Compared with age-matched WT pigs, MODY3 pigs showed a significant decrease in blood vessel density in the intermediate and deep vascular plexus at 4 and 7 months of age and a slight decrease in capillary density in the superficial vascular plexus at 7 months of age. In MODY3 pigs, electron microscopy revealed thickening of the capillary basement membrane and leukostasis in the major blood vessels at 10 months of age. Bradykinin-induced dilation of retinal arterioles was diminished in MODY3 pigs as early as 7 months of age. Within 1 year after birth, MODY3 pigs show all typical early vascular lesions of diabetes except for microaneurysm formation. This pilot study suggests that the MODY3 pigs may serve as a suitable DR model to test effects of newly developed compounds on DR.

A Case of Ocular Ischaemic Syndrome Associated with Choroidal Folds

A 58 year-old male patient presented with fluctuating vision in right eye. Dilated fundus examination on presentation showed wavy choroidal folds and cotton wool spots in the posterior pole of right eye. Fundus fluorescein angiogram demonstrated prolonged arm-to-retina circulation time and a patchy choroidal filling pattern in the same eye

CLINICAL PROFILE AND VISUAL OUTCOME AFTER ERM REMOVAL- AN EXPERIENCE FROM A TERTIARY CARE REFERRAL CENTER IN NORTH INDIA

Introduction: ERM is a cellular proliferation on the inner retinal surface and possesses contractile properties which leads to variable visual symptoms.
 Method: Thirty-four patients affected with epiretinal membrane were enrolled in this study. All patients underwent standard three port pars plana vitrectomy using standard 23-gauge instruments. Both ERM and ILM peels were performed in a circumferential pattern around the fovea. Patients were followed for 6 months. The visual outcome measures included postoperative logMAR visual acuity. The anatomical outcome was measured as decrease in foveal thickness on spectral domain optical coherence tomography (SD-OCT). Perioperative factors including duration of symptoms, preoperative visual acuity, etiology, membrane type and leakage on fundus fluorescein angiogram were correlated with the final visual outcomes.
 Results: The mean age of the patients in this study was 60.25 17.5 years with a range of 16 to 80 years. 19 patients (56%) were males. 33 patients had a unilateral ERM and 1 patient had an ERM in both eyes. Diminution of vision was the most common symptom in 34 patients, distortion of vision (metamorphopsia) was seen in 20 (58.8%) patients. The mean pre-operative log MAR best corrected visual acuity (BCVA) was 1.4±0.77 and the mean post-operative log MAR best corrected visual acuity (BCVA) was 0.9 ±0.63. Out of 34 patients in our study, 31 (91.2%) had improvement in VA, and the remaining 3 (8.82%) patients had no improvement and none of the patients had decreased vision. 16 patients had ≥2 lines of improvement in visual acuity. 15 patients had less than 2 lines of improvement.
 Conclusion: ERMs pose a significant risk to compromise the vision and affect varied age groups. ERM removal through standard three port pars plana vitrectomy offers an effective and safe procedure with better post operative visual outcomes.

A case of embolic non-arteritic anterior ischaemic optic neuropathy in a young patient

We report a rare case of unilateral non-arteritic anterior ischaemic optic neuropathy (NAAION) of embolic origin in a 47-year-old male caused by hypertriglyceridaemia and significant atherosclerotic stenosis of bilateral carotid arteries. The fundus fluorescein angiogram showed features supportive of an embolic aetiology. After left carotid endarterectomy and lipid-lowering therapy, there was complete resolution of disc oedema. Embolic anterior ischaemic optic neuropathy (AION) contributes to less than 10% of total AION cases and is often underevaluated. This case report emphasises the importance of thorough systemic evaluation by the ophthalmologist in patients with AION and the role of fundus fluorescein angiography (FFA) in establishing the aetiology in AION cases.

O31 Giant cell arteritis - a rare ocular presentation

O31 Giant cell arteritis - a rare ocular presentation

Occlusive retinal vasculitis in an immunocompetent woman: rare presentation of ocular melioidosis

Burkholderia pseudomallei is a known great mimicker responsible for melioidosis. Ocular involvement in melioidosis is unusual, with eyelid and orbital infection as the commonest presentation. We describe a 41-year-old, healthy woman who complained of reduced vision in her left eye. On examination, vision in the left eye was 6/9. There was evidence of occlusive retinal vasculitis on fundoscopy examination. Fundus fluorescein angiogram showed extensive capillary fallout. Diagnosis was established by a rise in the serum antibody titre for the bacterium and further supported by clinical improvement of vision after completion of treatment antibiotics. Sectoral panretinal photocoagulation at the capillary fallout area successfully arrested the sequelae of retinal ischaemia. Occlusive retinal vasculitis is a rare presentation of melioidosis. Early prompt diagnosis in an immunocompetent individual helps prevent visual-related morbidity. The ability of this bacteria to cause recurrent infection in an endemic area should not be underestimated.

P048 Cytomegalovirus retinitis in a patient with rheumatoid arthritis on tofacitinib

Abstract Background/Aims Cytomegalovirus (CMV) retinitis is one of the most common opportunistic ocular infections and has traditionally been associated with immunocompromised individuals. We present a case of CMV retinitis following 3 months of treatment with tofacitinib in conjunction with methotrexate (MTX) for rheumatoid arthritis (RA) in an elderly lady with no other co-morbidities. Methods The case is presented below. Results 69-year-old lady with long standing seronegative, anti-cyclic citrullinated peptide negative, erosive RA since 2016. She was intolerant of sulphasalazine, leflunamide, methotrexate and etanercept. Hydroxychloroquine was avoided due to idiopathic cystoid macular oedema in the right eye with a baseline visual acuity of 6/18. Baseline fundus fluorescein angiogram (FFA) was negative for any vascular, inflammatory or occlusive disease. She was escalated to tofacitinib in August 2019. Approximately 3 months later, she noticed significantly reduced vision in her right eye from 6/18 down to 6/60. She had an FFA and Indocyanine Green Angiography, which showed quite extensive retinal ischaemia and vasculitis. Her bloods revealed a raised serum ACE and a T-spot test from 2018 was reactive followed by a repeat in 2019 which was equivocal. Tofacitinib was discontinued. She was commenced on rifampicin and isoniazid as 3 months prophylaxis for latent tuberculosis (LTBI). Additionally, she was started on oral prednisolone 60mg daily for presumed sarcoid related retinal vasculitis. She failed to improve despite a week’s treatment and subsequently had a vitreous aspirate which was strongly positive for CMV PCR. Her CMV viral load was 267copies/ml. The aspirate was negative for other infectious agents. She was commenced on valganciclovir for CMV retinitis. Unfortunately, her vision remained unchanged despite the viral load becoming undetectable a few weeks later. Despite having LTBI, there was no reactivation of this with her immunosuppressive therapy. Conclusion CMV retinitis is usually associated with immunocompromised individuals and is rarely encountered related to tofacitinib therapy for rheumatoid arthritis. Tofacitinib suppresses T cell function by inhibiting STAT signalling pathways, modulating T cell activation and cytokine production. Our case highlights the preferential development of CMV retinitis over active TB in the presence of LTBI, which is a recognised risk with the use of JAK kinase inhibitors. TB risk has been associated with genetic mutations in IL-12, IFN-γ and STAT1 pathways while CMV activation may be influenced by mutations in HLA ,Toll-like receptors, immunoglobulin light chain antibodies, IFN lambda region as well as alternative transcripts of the CMV viral major immediate early genes. Disclosure K. Beharry: None. S. Kaur: None. E. Papagiannuli: None. S. Moses: None. D. De Lord: None.

New mathematical method for automating the analysis of fluorescein angiograms of the human fundus

To develop a method for automatic analysis of angiographic images of the fundus for early diagnosis of vascular disorders and complications in a number of ophthalmic diseases. Initial angiograms of patients (n=117) with vascular eye diseases and in healthy condition were analyzed in automatic mode using a new mathematical approach to digital processing of fundus fluorescein angiograms based on a three-stage algorithm for extracting information from images. A new mathematical method has been developed for the analysis fluorescein angiograms allowing for more complete results than with visual inspection of images, with image processing taking no more than 1 second in automatic mode. The developed method is based on fundamental results of the mathematical theory of image analysis and the joint use of image processing methods, mathematical morphology and mathematical statistics. The article introduces software implementations of the developed methods and presents the automated workplace of an ophthalmologist researcher.

Retinal vasculitis: An update with our experience

Retinal vasculitis is a sight-threatening inflammatory condition affecting the retinal vessels. It can occur due to several etiologies and spectrum of other ocular inflammatory conditions. It can occur as an isolated idiopathic condition, as a complication of infective or neoplastic disorders, or in association with systemic inflammatory disease. The various known etiologies have been discussed here with their characteristic features. Etiological diagnosis of retinal vasculitis can be challenging. Clinical examination, tailored laboratory investigations and multimodal imaging with fundus photography, fundus autofluorescence, fundus fluorescein angiography, indocyanine green angiography, swept-source optical coherence tomography (OCT), OCT angiography, B scan ultrasonography and in recent years widefield fundus fluorescein angiogram, imaging aids in the early diagnosis, monitoring and provides newer insights about these diseases. Newer treatment modalities and therapies such as immunomodulators and biologics have been added to the armamentarium against these sight-threatening conditions. Anti-vascular endothelial growth factor agents and laser photocoagulation are particularly beneficial to arrest the neovascularization process. The diagnosis of vasculitis may uncover an unknown underlying systemic cause. Early, effective, and prompt management can be vision saving and can minimize comorbidities. We feel that there is a necessity to update our knowledge on existing and newer trends in diagnosis, investigations, and management of retinal vasculitis. This review focuses on some of the basic concepts related to retinal vasculitis with an update.

Long-term Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: The LATAR Study: Report 1: Ten-Year, Real-World Outcomes

To report the 10-year outcomes of eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors. Ten-year, retrospective cohort study. A total of 1046 patients who commenced treatment with anti-VEGF for nAMD. Anti-VEGF-naïve eyes diagnosed with nAMD that commenced treatment between November 2006 and December 2009 were identified. Data collected included the baseline demographics, visual acuity (VA), and number of intravitreal injections. Baseline fundus fluorescein angiograms and OCT images were graded for choroidal neovascularization type. OCT images were graded for central macular thickness (CMT) and the presence of fluid over the 10 years. Change in vision at 10 years. Secondary outcomes included the proportion of eyes with 20/40 vision or better and 20/200 or worse, the proportion of eyes that were dry on OCT imaging, and the number of injections. Of 1046 eligible eyes, 10-year data were available for 293 (28%), which were included in the analyses. Eyes received 58.1 (standard deviation [SD], 33.6) injections during the 10 years. The mean CMT decreased from 355.5 μm (SD, 107.8 μm) to 264.2 (SD, 79.5) μm (P < 0.001). The median baseline VA was 60 (interquartile range [IQR], 45-70) letters, which improved by 9 (IQR, 1-14) letters after the first year of treatment (P < 0.001). Over the 10-year period, these initial gains were lost over time with a final VA change of+3 letters (IQR, 8-10 letters, P= 0.162). However, the proportion of eyes with VA 20/40 or better increased from 29% at baseline to 35% at 10 years (P < 0.001). The proportion of eyes at baseline with VA 20/200 or worse was 14% and 17% at 10 years. On average, eyes with nAMD maintained starting VA when treated with VEGF inhibitors for 10 years. With ongoing regular treatment, a greater proportion of eyes achieved VA of 20/40 or better at 10 years than at presentation.

Evaluation of the clinical utility of optical coherence tomography angiography in age-related macular degeneration

Background/AimsTo evaluate the ability of optical coherence tomography angiography (OCTA) to identify the presence or absence of choroidal neovascularisation (CNV) and CNV activity in age-related macular degeneration (AMD).MethodsClinical parameters, fundus...

An Atypical Presentation of Giant Cell Arteritis with Bilateral Choroidal Ischaemia

Background: Giant cell arteritis is an immune-mediated, medium to large vessel vasculopathy affecting individuals over 50 years of age. It can cause sudden, severe and irreversible loss of vision, most commonly from an arteritic posterior ciliary artery occlusion causing anterior ischaemic optic neuropathy. The optic nerve appearance would typically be swollen and chalky white. Visual reduction secondary to choroidal ischaemia is a much less frequent presentation, the signs of which can be more subtle in appearance, making its early recognition potentially more challenging. Case Presentation: A 51-year-old male presented to eye casualty complaining of a one-week history of neck pain, intermittent headaches and jaw claudication, associated with reduced vision in his right eye. Presenting visual acuity was hand movements and 6/5 in the right and left eyes respectively. On examination, he was noted to have a right relative afferent pupillary defect, a pale macular area in the right eye with a possible cherry red spot. There was no optic disc swelling. ESR was 34 and CRP was 46 and he was wrongly diagnosed with a non-arteritic central retinal artery occlusion. He subsequently re-presented 5 weeks later with vision loss in his left eye. Best corrected visual acuity was now 6/60 and 6/12 in the right and left eyes respectively. Dilated fundoscopy showed multiple yellow-white lesions in the posterior pole of the left eye and a retinal cotton wool spot. The right optic nerve was pale, and left was normal. A fundus fluorescein angiogram showed delayed choroidal filling and the temporal artery biopsy was suggestive of GCA. He was started on 110mgs of oral prednisolone. After 4 weeks of steroids his BCVA was 6/36 and 6/6 in the right and left eyes respectively. His neck pain, headaches and jaw claudication had all resolved and his ESR and CRP had returned to normal levels. Conclusion: Our case highlights the need for increased awareness of this uncommon presentation of this potentially blinding disease, to allow prompt and appropriate treatment. Our case is unusual in that despite a delayed diagnosis of 5 weeks, visual acuity initially improved with treatment.

Combined central retinal vein, central retinal artery and cilioretinal artery occlusion with ischemic macular hole secondary to severe orbital cellulitis after black fly bite.

Background: Orbital cellulitis is an infection of the ocular adnexal and orbital tissues behind the orbital septum. The complications are poor prognosis. This paper is to describe some severe rare complications of orbital cellulitis.Case presentation: A case of 32-year-old female presented with acute severe progressive orbital cellulitis on the right eye after a black fly (Simuliidae spp.) bite. Orbital imaging with computed tomography and magnetic resonance imaging showed eyelid abscess with orbital abscess formation and superior ophthalmic vein thrombosis. She was promptly treated with intravenous vancomycin, piperacillin and had surgical procedures to release orbital pressure including lateral canthotomy, lateral cantholysis, and eyelid with orbital abscess drainage. Pus collection culture was positive for Staphylococcus aureus. Even though she responded well to antibiotics treatment, progression involved severe orbital inflammation with marked increased orbital pressure, and her visual acuity was such that she had no light perception. Combined central retinal vein, central retinal artery and cilioretinal artery occlusion were identified. Fundus examination showed retinal whitening at the posterior pole and a few scattered flame-shaped retinal hemorrhages. The cilioretinal artery presented with perivascular retinal whitening. A fundus fluorescein angiogram revealed cilioretinal and retinal artery filling delay and also delayed arteriovenous transit time. She also developed an ischemic macular hole after a week of treatment. We demonstrate an optical coherence tomography image showing the intact posterior hyaloid membrane that represents no traction on the macula to support the ischemic cause.Conclusion: Multiple retinal vascular occlusion and ischemic macular hole could be an early complication of severe orbital cellulitis from increased orbital pressure; therefore, close monitoring of visual acuity with IOP, and prompt treatment when indicated might reduce the risk of consequent blindness.

Clinical Features and Multi-Modality Imaging of Isolated Retinal Astrocytic Hamartoma.

To identify the clinical and imaging characteristics of isolated retinal astrocytic hamartomas (IRAH). A case series of eight patients diagnosed with IRAH. The average age at diagnosis was 32 years (range: 9 years to 80 years). After a median follow-up time of 59 months, none of the lesions had demonstrated any change or growth. Fundus fluorescein angiogram identified hyperfluorescence in five of six imaged lesions. Fundus autofluorescence (FAF) changes were seen in all eight cases. Ocular ultrasound was able to identify a lesion in only five of the seven cases. Optical coherence tomography (OCT) was able to document the tumor thickness and level of retinal invasion in all cases. Multimodal imaging is useful for the diagnosis and monitoring of IRAH. OCT and FAF are sensitivity tools for identifying IRA and can be used to follow the thickness and margins of these lesions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e1-e9.].

Optical coherence tomography in the evaluation of disc edema

Optic disc oedema is a common clinical problem where the ophthalmologist plays an important role in the diagnosis, management. Many optic nerve diseases can cause disc oedema like papilloedema, papillitis, anterior ischaemic optic neuropathy, central retinal vein occlusion, optic nerve head drusen etc. It is important to differentiate pseudoneuritis as in hypermetropia from true disc oedema. The clinical features, fundus examination sometimes may not give the correct diagnosis. Fundus fluorescein angiogram helps to differentiate pseudo from true disc oedema. However it is an invasive procedure. With newer technologies like optical coherence tomography which helps to image the optic disc, it is possible to differentiate pseudo from true disc oedema, also to recognise the aetiology of disc oedema. In this review article we are highlighting the OCT findings in various causes of disc oedema.

Iodate induced toxic retinopathy: a case report

BackgroundIodine deficiency is a common preventable cause of intellectual and developmental disabilities. Iodine in the form of potassium iodate is added to the common salt under the National Iodine Deficiency Disorder Control Program in India. Overdose of iodate can lead to retinal toxicity.Case presentationWe hereby present a case of a 34 year old male patient who presented to us 10 years following iodate ingestion. There was widespread outer retinal atrophy, foveal atrophy and sub-retinal fibrosis noted on fundus evaluation. The fundus fluorescein angiogram was suggestive of window defects while the scotopic electroretinogram showed diminished amplitude pointing towards a grave prognosis.ConclusionsExcessive ingestion of potassium iodate can lead to outer retinal atrophy due to its toxicity to the retinal pigment epithelium and photo-receptors. The degree of damage is dependent on the ingested dose.

Fundus fluorescein angiography of idiopathic central serous chorioretinopathy in the indigenous population of Manipur

Background: Idiopathic central serous chorioretinopathy is a chorioretinal disease characterized by localized leakage from the choroidal circulation causing serous retinal detachment affecting the macula. Aims: To document the leakage pattern using fundus fluorescein angiogram in idiopathic central serous chorioretinopathy in the indigenous people of Manipur. Materials and Methods: A prospective study was conducted in all patients with clinical diagnosis of central serous chorioretinopathy attending ophthalmology outpatient department of a tertiary care hospital in Manipur, Northeast India, within a period of 1 year starting from September 2015 to August 2016. After thorough clinical evaluation of the posterior segment and after ruling out the potential contraindications, patients were subjected to fundus fluorescein angiography (FFA). Results: Predominantly males (72%) and those mostly in their fifth decade of life were affected. Most of the patients were businessmen. The right eye was affected more (78%) than the left, with the most common presenting symptom being dark shadow or central haziness of vision in about 60% of patients. Betel nut consumption was found to be a very common food habit. Sensory retinal detachment (40%) was the most common fundus finding and depigmented patches (4%) were least commonly seen. Of the 50 eyes examined, FFA showed a single leak in 36, double and triple leaks in 7 eyes each, and no leak in 10 eyes. Inkblot pattern was the most common pattern of leakage (72%). Most common site of leakage in this study was the macular area (58%). Conclusion: Idiopathic central serous chorioretinopathy (ICSC) predominantly affects middle-aged males having a stressful life. Most of them present with dark shadow or a central area of haziness in the visual field which is mostly attributable to sensory retinal detachment at the macula. The most common fundus fluorescein angiographic finding is a single leak inkblot pattern in the macular area.