Hypertensive Choroidopathy Revealing Malignant Hypertension in a Young Patient

Verstappen, Marie; Draganova, Dafina; Judice, Lia; Makhoul, Dorine; Papadaki, Maria A.; Caspers, Laure; Willermain, François

doi:10.1097/iae.0000000000002509

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…Elschnig spots appear as areas of early hyperfluorescence with late subretinal leakage. 12,13 There may also be optic disc leakage and blockage from cotton wool spots and intraretinal hemorrhages ( Figure 5 Differential diagnoses for hypertensive chorioretinopathy include diabetic retinopathy, radiation retinopathy, anemia and other blood dyscrasias, ocular ischemic syndrome, and retinal vein occlusion. Clinical history and the presence of elevated blood pressure are valuable for distinguishing hypertensive chorioretinopathy from the aforementioned conditions.…”

Section: Diagnosis Of Hypertensive Chorioretinopathymentioning

confidence: 99%

“…20 Hypertensive chorioretinopathy is seen more commonly in younger patients with acute elevations in blood pressure and is associated with a poor prognosis if left untreated. It has been reported in conditions such as malignant hypertension, 13,20 pre-eclampsia, 21 eclampsia, 22 acute or chronic renal failure, 23,24 renal artery stenosis, 25 and adrenal carcinoma. 26 These conditions are all medical emergencies that require immediate treatment.…”

Section: Significance Of Hypertensive Chorioretinopathymentioning

confidence: 99%

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<p>A Review of Hypertensive Retinopathy and Chorioretinopathy</p>

Tsukikawa¹,

Stacey²

2020

OPTO

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Hypertensive retinopathy and choroidopathy have important short-and long-term implications on patients' overall health and mortality. Eye care professionals should be familiar with the severity staging of these entities and be able to readily recognize and refer patients who are in need of systemic blood pressure control. This paper will review the diagnosis, staging, treatment, and long-term implications for vision and mortality of patients with hypertensive retinopathy and choroidopathy.

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Section: Diagnosis Of Hypertensive Chorioretinopathymentioning

confidence: 99%

Section: Significance Of Hypertensive Chorioretinopathymentioning

confidence: 99%

<p>A Review of Hypertensive Retinopathy and Chorioretinopathy</p>

Tsukikawa¹,

Stacey²

2020

OPTO

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“…Hypertensive choroidopathy, however, has been reported in toxemia of pregnancy, renal disease and malignant hypertension. 9,10 In view of the temporal onset of clinical manifestation and symptoms and the absence of thrombotic microangiopathy, in our opinion, the bilateral serous retinal detachment observed in our patient was secondary to the acute hypertension rather than the pathology itself or any of the medications used. At the same time, we could not find evidence either in the drug safety information provided by the manufacturers or in the literature, that the medications used in this case are completely safe and could not have aggravated the acute condition caused by poor hypertensive control in this patient.…”

Section: Discussionmentioning

confidence: 49%

Hypertensive choroidopathy in atypical hemolytic-uremic syndrome

Polito

Machetta

Fea

et al. 2019

European Journal of Ophthalmology

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Purpose: We present the case of a 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome with a hypertensive crisis, who presented a bilateral serous retinal detachment. Case Description: A 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome, was referred for blurred vision in both eyes, evolving over 7 days. Treatment including hemodialysis, plasma exchange, systemic steroids, antihypertensive medications and eculizumab was started 1 month prior to referral. At presentation, best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye. Retinal examination revealed bilateral serous retinal detachment in the posterior pole and some small, flat, variably pigmented lesions. Optical coherence tomography confirmed marked serous retinal detachment in both eyes. Fluorescein and indocyanine green angiography was performed. Treatment for systemic hypertension was changed. Seven days later, dilated fundus examination and optical coherence tomography demonstrated a significant regression of the serous retinal detachment. Her visual acuity improves in both eyes at the last control, showing at fundus examination a complete resolution of the exudative detachment but a persistence of variable flat pigmented lesion. Conclusion: Although multiple organ systems are commonly affected in hemolytic uremic syndrome, ocular involvement has only been described in very few cases. Ocular manifestations in atypical hemolytic uremic syndrome include retinal, choroidal and vitreal hemorrhages, retina and/or ischemic signs. Bilateral serous retinal detachment may also be a sign of atypical hemolytic uremic syndrome or even the first manifestation of a hypertensive event.

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“…However, patients with malignant hypertensive retinopathy may report decreased vision, and irreversible profound visual loss is possible. Similarly, patients with hypertensive choroidopathy should be referred to emergency departments for urgent anti-hypertensive management, [219][220][221][222] and may be considered for more aggressive ocular intervention such as intravenous anti-VEGF treatment. 219 Finally, whether specific anti-hypertensive agents have particular value in the treatment of hypertensive retinopathy is unclear.…”

Section: Management Of Hypertensive Eye Diseasementioning

confidence: 99%

Hypertensive eye disease

Cheung

Biousse

Keane

et al. 2022

Nat Rev Dis Primers

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Hypertensive eye disease includes a spectrum of pathological changes, the most wellknown being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (e.g., kidney disease) elsewhere in the body.Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence (AI), and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.

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Hypertensive Choroidopathy Revealing Malignant Hypertension in a Young Patient

Cited by 8 publications

References 5 publications

<p>A Review of Hypertensive Retinopathy and Chorioretinopathy</p>

<p>A Review of Hypertensive Retinopathy and Chorioretinopathy</p>

Hypertensive choroidopathy in atypical hemolytic-uremic syndrome

Hypertensive eye disease

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