Hypertensive choroidopathy: Multimodal imaging and the contribution of wide-field swept-source oct-angiography

Abstract

PurposeTo present the case of a patient with a hypertensive choroidopathy and her follow-up using multimodal imaging; and to assess how wide-field swept-source (SS) Optical Coherence Tomography Angiography (OCTA) contributes to detecting the areas of hypoperfusion.ObservationsA 25-year-old white woman with terminal renal insufficiency, myopericarditis, and cerebrospinal fluid pressure of 37 mmHg indicating intracranial hypertension, presented with a painless loss of vision in both eyes. Her blood pressure was 190/135 mmHg. A thorough diagnosis work-up failed to reveal the etiology. The fundus examination showed arterial narrowing and moderate venous dilation in both eyes. Deep yellow spots were found bilaterally, associated with slight pigment epithelium detachments and exudative retinal detachments. Multimodal imaging showed characteristic features of choroidal involvement in hypertension. Wide-field 12 × 12 mm PlexElite map montage at the choriocapillaris slab identified areas of non-perfusion of the choriocapillaris. These areas mostly correlate with late indocyanine green angiography (ICGA)-presumed choroidal ischemia. During the follow-up, the patient's blood pressure normalized and the choriocapillaris flow improved.Conclusions and importanceIn this case of malignant hypertensive retinopathy with exudative retinal detachment of the posterior pole, SS-OCTA showed multiple and widespread flow voids on the choriocapillaris slabs, corresponding to the areas of hypofluorecence on ICGA, demonstrating an associated hypertensive choroidopathy. It would appear that SS-OCTA used alone is capable to show choroidal vascularization impairment in cases of hypertensive retinopathy.

Acute choroidal involvement in lupus nephritis: A case report and review of literature

“…Polito et al [ 15 ] reported that plasmapheresis could improve the choroidopathy, which indicated the importance of immune complex deposition in the pathophysiology and management strategy of the disease. Secondly, uncontrolled hypertension may cause choroidal vascular occlusions, leading to ischemia and destruction of the external blood-retinal barrier at the RPE[ 16 ]. Thirdly, thrombosis can also lead to choroidopathy by causing microangiopathy[ 8 ].…”

Longitudinal Optical Coherence Tomography Angiography Findings in Malignant Hypertension Choroidopathy: A Case Report

“…Hypertensive choroidopathy typically occurs in younger individuals as vascular constriction requires pliable vessels [ 3 ]. Rezkallah et al [ 6 ] described the use of OCTA in a young patient with malignant hypertension to assess choroidal flow loss, which in that particular case was primarily extramacular and likely explained the mild SRF in the macula. In contrast, our patient is older and presented with choroidal flow loss in the central macula and massive central SRF, both of which improved with systemic BP normalization.…”

Ischemic Choroidal Diseases

“…Occlusion of small choroidal terminal arterioles and capillaries results in areas of circumscribed choroidal reduced perfusion, which can be visualised as hypofluorescent areas in the early stages of fluorescein angiography (FLA) and indocyanine green angiography (ICGA) [1]. While these areas remain hypofluorescent in the late phase of ICGA, they are visible as multiple hyperfluorescent spots in FLA. OCT-A can also be utilised to visualise reduced blood flow in the choriocapillaris [4]. At biomicroscopic examination, they appear as multifocal, pale-yellow spots in the area of reduced perfusion, particularly in the posterior fundus.…”

“…Während diese Areale auch in der Spätphase der ICGA hypofluoreszent bleiben, erscheinen sie in der FLA als multiple hyperfluoreszente Flecken. Auch mittels OCT-A lässt sich der reduzierte Blutfluss in der Choriokapillaris darstellen [4]. Biomikroskopisch zeigen sie sich im Bereich der Minderperfusion als multifokale, blass gelbe Flecken, vor allem am hinteren Pol.…”