Ophthalmic Surgery, Lasers and Imaging Retina

Images in Ophthalmology 

“Geyser” Leakage on Fluorescein Angiography

Jaime Levy, MD; Xavier J. Fagan, FRANZCO; Tova Lifshitz, MD; Marina Schneck, MD

Abstract

An 82-year-old patient with diabetes was followed up due to moderate nonproliferative diabetic retinopathy with macular edema in the right eye. Visual acuity was 6/36. Focal macular laser was conducted (A). Three years later, the patient presented with blurry vision in the right eye. Visual acuity was 3/60. Vitreous hemorrhage was observed (B), and neovascularization of the disc was suspected (C). Fluorescein angiography (D, mid venous phase; E-F, recirculation phase) confirmed neovascularization of the disc and depicted a striking vertical leakage. Panretinal photocoagulation was started. Possible explanations for the “geyser” leakage may be either a partial posterior vitreous detachment allowing the fluorescein to track upwards but not elsewhere or a pocket of syneretic vitreous allowing the fluorescein passage in which to diffuse, much like the passage the blood would have taken.

[Ophthalmic Surg Lasers Imaging Retina. 2014;44:E23.]

From the Ophthalmology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (JL, TL, MS); and the Medical Retina Unit, Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (XJF).

The authors have no financial or proprietary interest the materials presented herein.

Address correspondence to Jaime Levy, MD, Department of Ophthalmology, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel; +972-8-640-0379; fax: +972-8-640-3927; email: ljaime@bgu.ac.il.

Received: January 08, 2013
Accepted: August 21, 2013
Posted Online: November 22, 2013

Abstract

An 82-year-old patient with diabetes was followed up due to moderate nonproliferative diabetic retinopathy with macular edema in the right eye. Visual acuity was 6/36. Focal macular laser was conducted (A). Three years later, the patient presented with blurry vision in the right eye. Visual acuity was 3/60. Vitreous hemorrhage was observed (B), and neovascularization of the disc was suspected (C). Fluorescein angiography (D, mid venous phase; E-F, recirculation phase) confirmed neovascularization of the disc and depicted a striking vertical leakage. Panretinal photocoagulation was started. Possible explanations for the “geyser” leakage may be either a partial posterior vitreous detachment allowing the fluorescein to track upwards but not elsewhere or a pocket of syneretic vitreous allowing the fluorescein passage in which to diffuse, much like the passage the blood would have taken.

[Ophthalmic Surg Lasers Imaging Retina. 2014;44:E23.]

From the Ophthalmology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (JL, TL, MS); and the Medical Retina Unit, Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (XJF).

The authors have no financial or proprietary interest the materials presented herein.

Address correspondence to Jaime Levy, MD, Department of Ophthalmology, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel; +972-8-640-0379; fax: +972-8-640-3927; email: ljaime@bgu.ac.il.

Received: January 08, 2013
Accepted: August 21, 2013
Posted Online: November 22, 2013

10.3928/23258160-20131111-03

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