Smoke-stack fluorescein leakage in a vitrectomised eye with proliferative diabetic retinopathy: a rare angiographic phenomenon.

Background/aim: This case report aims to describe an unusual angiographic finding of smoke-stack leakage (SSL) in a vitrectomised eye of a patient with proliferative diabetic retinopathy (PDR).

Case description: A 59-year-old male with a 17-year history of type 2 diabetes mellitus underwent fundus fluorescein angiography (FA) following vitrectomy for vitreous hemorrhage secondary to PDR. His visual acuity at the time of FA was 6/6 in both eyes. The examination focused on identifying neovascularization elsewhere (NVE) and analysing leakage patterns. FA revealed active NVEs in the left eye with late-phase leakage nasally and inferiorly to the optic disc, while the right eye exhibited a distinctive SSL pattern from residual proliferation. Interestingly, the leakage subsided in the late phase, leaving only staining of the residual fibrous tissue.

Conclusion: The observed SSL in this vitrectomised eye underscores unique post-surgical dynamics of fluorescein diffusion. This case highlights the importance of recognizing altered leakage patterns in vitrectomised patients, which can impact the evaluation and management of retinal neovascularization in PDR.