Purpose: To report a series of cases with smokestack leakage on fundus fluorescein angiography outside the clinical setting of central serous chorioretinopathy. Methods: A multicenter, observational retrospective case series evaluating fundus fluorescein angiography on Topcon and Optos systems. Results: Seven patients with neovascularization due to ischemic retinopathy demonstrated a unique smokestack pattern of angiographic leakage. The patients' ages ranged between 44 and 71 years and were seen at 3 academic teaching hospitals in the Washington–Baltimore metropolitan area. Five patients had been diagnosed with proliferative diabetic retinopathy, one with sickle cell ischemic retinopathy, and one with branch retinal artery occlusion; none of the patients had a known history or clinical signs of current or past central serous chorioretinopathy. Conclusion: This is the first published case series to the author's knowledge of ischemic retinopathy displaying a smokestack leakage pattern on fundus fluorescein angiography that is classically described with idiopathic central serous chorioretinopathy.
Hippotherapy has recently emerged as a horse-based rehabilitative therapy to improve balance, coordination, and strength in patients with a wide range of medical conditions. Although several studies have demonstrated its effectiveness in restoring balance and gait in patients who have suffered cerebrovascular accidents (CVA), few studies have reported on adverse events associated with the treatment.This case report describes a female post-stroke patient who fell from a horse during a hippotherapy session. She suffered a closed right zygomaticomaxillary complex fracture and ruptured globe injury. The patient's orbital injuries were surgically repaired, yet ultimately left her with no light perception in the affected eye and required enucleation.Ocular and orbital injuries following hippotherapy are potentially blinding yet preventable. As such, practitioners should weigh the risks and benefits of hippotherapy, particularly in patients with unstable gait, and advise that additional safety precautions are taken to avoid these devastating injuries.
