|Year : 2022 | Volume
| Issue : 1 | Page : 292-293
Chimney leak in proliferative diabetic retinopathy
Nikitha Gurram Reddy1, Ramesh Venkatesh1, Sameeksha Agrawal1, Pranjal Mishra1, Jay Chhablani2
1 Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, Karnataka, India
2 University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, Pittsburg, PA, USA
|Date of Submission||07-May-2021|
|Date of Acceptance||23-Aug-2021|
|Date of Web Publication||07-Jan-2022|
Dr. Ramesh Venkatesh
Narayana Nethralaya, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore - 560 010, Karnataka
Source of Support: None, Conflict of Interest: None
Keywords: Chimney leak, fluorescein angiography, leakage pattern, proliferative diabetic retinopathy
|How to cite this article:|
Reddy NG, Venkatesh R, Agrawal S, Mishra P, Chhablani J. Chimney leak in proliferative diabetic retinopathy. Indian J Ophthalmol Case Rep 2022;2:292-3
|How to cite this URL:|
Reddy NG, Venkatesh R, Agrawal S, Mishra P, Chhablani J. Chimney leak in proliferative diabetic retinopathy. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 19];2:292-3. Available from: https://www.ijoreports.in/text.asp?2022/2/1/292/334856
A 62-year-old female, diabetic for 20 years, was referred for diabetic retinopathy (DR) screening. Corrected visual acuity was 6/6, 6/6RS in both eyes. Intraocular pressure and anterior segment examination were normal. Both eye fundus showed features of severe nonproliferative DR (SNPDR) with no macular edema. Right eye (RE) fundus showed a small red tuft of vessels along the superotemporal arcade suggestive of a suspicious retinal neovascularization (NV) [Figure 1]a. Optical coherence tomography scan through NV showed an elevated lesion on the retinal surface, protruding into the vitreous [Figure 1]b. A retinal NV was confirmed showing a late intense leakage on fluorescein angiography (FA). There was an interesting chimney-like leak emanating from the NV into the superior retinal periphery in late FA [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e. Findings were suggestive of PDR in RE and SNPDR in the left eye.
|Figure 1: Color fundus and optical coherence tomography (OCT) scans in a patient with proliferative diabetic retinopathy: (a) Color fundus photograph of the right eye using the Optos, Daytona showing possible retinal neovascularization (black arrow) along the superotemporal arcade in patient with diabetic retinopathy. (b) OCT line scan (Spectralis, Heidelberg) through the suspected NV shows the lesion to be elevated from the retinal surface and protruding toward the vitreous cavity (white arrow). There was no macular edema on OCT in the right eye|
Click here to view
|Figure 2: (a–e) Chimney-like leakage from the retinal neovascularization due to proliferative diabetic retinopathy along the different phases of fluorescein angiogram|
Click here to view
| Discussion|| |
We demonstrate an unusual FA leakage finding in PDR and pictorially call it “chimney leak.” Routinely, retinal NV demonstrates an intense diffuse leakage pattern during late FA. Leakage intensity from NV depends on the vasculature within it, associated vitreoretinal interface changes, and vitreous traction.,,, No such change was noted in our case. Our hypothesis for this leakage pattern is similar to the mechanism of smoke-stack leak in central serous chorioretinopathy and retinal meteor-leak in vasoproliferative tumors., Retinal hypoxia causes retinal ischemia, which triggers retinal physiological and pathological changes. This creates pressure gradients across the vitreous, retina, and choroid, causing leakage of free fluorescein from the retinal vessels into the vitreous due to inner blood–retina barrier breakdown. There is a temperature difference across the different eye structures in DR. The anterior part of the eye is cooler compared to its posterior part. This temperature difference between the cooler vitreous and warmer retina could stimulate the convection currents.
Thus, multiple factors such as high unbound fluorescein, pressure, and temperature difference between retina and vitreous and development of convection currents could precipitate this chimney-type leak in PDR.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Grading diabetic retinopathy from stereoscopic color fundus photographs--An extension of the modified airlie house classification. ETDRS report number 10. Early treatment diabetic retinopathy study research group. Ophthalmology 1991;98 (5 Suppl):786-806.
Salz DA, Witkin AJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol 2015;22:145-50.
] [Full text]
Rasta SH, Nikfarjam S, Javadzadeh A. Detection of retinal capillary nonperfusion in fundus fluorescein angiogram of diabetic retinopathy. Bioimpacts 2015;5:183-90.
Cho H, Alwassia AA, Regiatieri CV, Zhang JY, Baumal C, Waheed N, et al
. Retinal neovascularization secondary to proliferative diabetic retinopathy characterized by spectral domain optical coherence tomography. Retina 2013;33:542-7.
Bujarborua D, Nagpal PN, Deka M. Smokestack leak in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2010;248:339-51.
Venkatesh R, Gurav P, Dave PA, Roy S. Retinal meteor. Indian J Ophthalmol 2017;65:879-81.
] [Full text]
Sodi A, Giambene B, Miranda P, Falaschi G, Corvi A, Menchini U. Ocular surface temperature in diabetic retinopathy: A pilot study by infrared thermography. Eur J Ophthalmol 2009;19:1004-8.
[Figure 1], [Figure 2]