Central Serous Chorioretinopathy MCQ — NEET PG Practice Question | NEETPGAI
Central Serous Chorioretinopathy
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eye Ophthalmology
A 38-year-old male marketing executive presents with central grey blur and micropsia in the right eye for two weeks. Best-corrected acuity is 6/12 with a hypermetropic shift. Dilated fundoscopy reveals a dome-shaped serous detachment at the posterior pole with loss of foveal reflex. Fluorescein angiography demonstrates a single focal hyperfluorescent spot at the superotemporal edge of the detachment that progressively expands upward and then spreads laterally in a classic smokestack pattern (marked **A** in the diagram). This pattern of leakage originates from which of the following?
A. A focal defect in the retinal pigment epithelium with underlying pachychoroid hyperpermeability
B. Rupture of the internal limiting membrane with vitreous traction on the macula
C. Occlusion of a branch retinal artery at the posterior pole
D. Neovascularization of the retinal pigment epithelium secondary to chronic inflammation
Explanation
Why option 1 is correct
The smokestack hyperfluorescent leak pattern (marked A) is the pathognomonic fluorescein angiographic finding in acute central serous chorioretinopathy. This pattern originates from a focal defect in the retinal pigment epithelium (RPE), through which fluid from the underlying choroid (which is thickened and hyperpermeant in pachychoroid disease) leaks into the subretinal space. The characteristic upward and lateral spread mimics smoke rising from a chimney. Ryan's Retina emphasizes that this focal RPE defect is the site of active leakage, and the underlying pachychoroid with dilated choroidal vessels (confirmed on indocyanine green angiography) drives the fluid accumulation. The patient's risk factors (corticosteroid use, stress, caffeine) are known triggers for RPE dysfunction in CSCR.
Why each distractor is wrong
Option 2 (Internal limiting membrane rupture with vitreous traction): This would cause a rhegmatogenous retinal detachment with a break visible on fundoscopy, not a serous detachment. The pattern of leakage would be diffuse, not a focal smokestack leak. ILM rupture is not associated with CSCR pathophysiology.
Option 3 (RPE neovascularization secondary to inflammation): Neovascularization of the RPE is not a feature of acute CSCR. While chronic CSCR may lead to RPE changes, the acute presentation with a focal RPE defect and smokestack leak is not driven by neovascularization. This distractor confuses CSCR with other retinal conditions like polypoidal choroidal vasculopathy.
Option 4 (Branch retinal artery occlusion): Arterial occlusion would cause retinal whitening and flame hemorrhages in the distribution of the occluded vessel, not a focal hyperfluorescent leak. The fluorescein pattern would show delayed filling of the artery, not a progressive smokestack leak from the RPE.
High-YieldNEET PG
The smokestack leak in CSCR is a focal RPE defect allowing choroidal fluid to accumulate subretinally; it is the hallmark angiographic sign and guides diagnosis and treatment decisions.
Ryan's Retina, 6th ed., Ch. Central Serous Chorioretinopathy
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