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CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 86-87

Peripapillary exudative retinal detachment: An unusual manifestation of hypertensive choroidopathy


1 Department of Ophthalmology, St. John's Medical College Hospital, Bangalore, Karnataka, India
2 Department of Obstetrics and Gyneacology, St. John's Medical College Hospital, Bangalore, Karnataka, India

Date of Web Publication5-Jun-2015

Correspondence Address:
Dr. Sangeetha Sriram
Department of Ophthalmology, St John's Medical College Hospital, Sarjapur Road, Bangalore - 560 005, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-5617.150210

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  Abstract 

We report a case of hypertensive choroidopathy presenting with peripapillary serous detachment in a patient with chronic hypertension with super imposed pre-eclampsia. The fundus evaluation showed grade 4 hypertensive retinopathy changes with peripapillary serous detachment which was confirmed on Optical coherence tomography. This is an unusual presentation, as these changes are commonly seen in the macular region.

Keywords: Grade 4 hypertension, hypertensive choroidopathy, peripapillary serous retinal detachment


How to cite this article:
Sriram S, Nithyanandam S, Ramkumar V, Joseph J. Peripapillary exudative retinal detachment: An unusual manifestation of hypertensive choroidopathy. Egypt Retina J 2014;2:86-7

How to cite this URL:
Sriram S, Nithyanandam S, Ramkumar V, Joseph J. Peripapillary exudative retinal detachment: An unusual manifestation of hypertensive choroidopathy. Egypt Retina J [serial online] 2014 [cited 2020 Dec 2];2:86-7. Available from: https://www.egyptretinaj.com/text.asp?2014/2/2/86/150210


  Introduction Top


Hypertensive retinopathy is well known, but choroidopathy is uncommon and associated with acute increases in blood pressure. Ocular manifestations of hypertension involve both retinal and choroidal circulation. Clinical and pathological studies suggest that choroidal changes are present in benign and malignant hypertension, though significantly greater in the latter. Acute ischemic changes in the choriocapillaries and overlying retinal pigment epithelium result in acute, focal retinal pigment epithelial lesions. Serous retinal detachments, which preferentially affect the macular region, cause neurosensory retinal detachments and cystoid macular edema. We report a case of peripapillary serous exudative retinal detachment in eclampsia as this site is highly unusual for an exudative retinal detachment and not been reported so far to the best of our knowledge. Most retinal changes secondary to malignant hypertension will improve once blood pressure is controlled. Damage to the optic nerve and macula, however, could cause long term reductions in visual acuity. Clinical evidence of choroidopathy from hypertension has a significant prognostic value for life. Termination of pregnancy may be indicated in cases where systemic signs of toxemia are controlled medically but there is no flattening of the detached retina. Hence early recognition and referral will improve the quality of vision in such patients.


  Case Report Top


A 25-year-old female patient who was pregnant for the 5 th time presented to us with complaints of blurring of vision of 2 days duration and 12 weeks amenorrhea, with previous 4 pregnancies terminated at 6 months gestation due to severe pre-eclampsia. On examination her best corrected visual acuity was 20/40 in the right eye and 20/60 in the left eye. The color vision and pupillary reaction were normal. On fundus evaluation both optic discs were elevated with a surrounding halo of serous detachment of the peripapillary retina, along with the presence of macular edema and macular star [Figure 1]. There were also severe arteriolar attenuation with arterio-venous crossing changes and Elschnig spots in the periphery in both eyes. Optical coherence tomography (OCT) using the macular cube protocol over the disc to study the peripapillary retina was performed. The OCT showed waveform pattern in the peripapillary retinal pigment epithelial layer (RPE) with an area of RPE upward shift by the underlying fluid in the choroid [Figure 2]. A similar OCT finding was also demonstrated by Young-seok Song et al. [1]
Figure 1: Color photograph of both eyes showinga halo (arrowheads) of serous detachment of the peripapillary retina, along with macular edema and macular star

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Figure 2: Spectral domain Optical coherence tomography scan showing a waveform pattern in the peripapillary retinal pigment epithelial layer [RPE]. Note the area of RPE upward shift by the underlying fluid in the choroid

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  Discussion Top


Hypertensive choroidopathy is commonly seen in malignant hypertension, renal disease, pheochromocytoma and toxemia of pregnancy. [2] When there is acute rise in systemic blood pressure the autoregulatory capacity of the body is exceeded, this causes fibrin platelet obstruction which leads to obstruction of choroidal arteries and choriocapillaries. This in turn causes necrosis of the overlying retinal pigment epithelium which results in fibrinous exudation. [3] The location of these changes is commonly seen in the macular region. However in our patient it is manifested as a halo of peripapillary exudative detachment which has not been reported in literature to the best of our knowledge. Two other manifestations of hypertensive choroidopathy are Elschnig spots which were also seen in our patient and Seigrist streaks. These changes are different from the more superficial retinal infarcts and retinal hard exudates seen in accelerated and chronic hypertension. Our case report highlights an unusual manifestation of hypertensive choroidopathy. Prompt recognition and accurate diagnosis of hypertensive retinopathy and choroidopathy in patients with pre-eclampsia are important to reduce the morbidity and mortality in these patients.

 
  References Top

1.
Song YS, Kinouchi R, Ishiko S, Fukui K, Yoshida A. Hypertensive choroidopathy with eclampsia viewed on spectral domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2013;251:2647-50.  Back to cited text no. 1
    
2.
Chatterjee S, Chattopadhya S, Hope-Ross M, Lip PL. Hypertension and the eye: Changing perspectives. J Hum Hypertens 2002;16:667-75.  Back to cited text no. 2
    
3.
Bourke K, Patel MR, Prisant M, Marcus DM. Hypertensive choroidopathy. J Clin Hypertens 2007;6:471-2.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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