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

• Published in: American journal of ophthalmology case reports Vol. 13; pp. 131 - 135
• Main Authors: Rezkallah, Amina, Kodjikian, Laurent, Abukhashabah, Amro, Denis, Philippe, Mathis, Thibaud
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01-03-2019
• Subjects: Case report; Engineering Sciences; Materials; Hypertensive choroidopathy; Multimodal imaging; Swept-source optical coherence tomography angiography; B scan; intraocular pressure; Article; kidney failure; case report; retina hemorrhage; cerebrospinal fluid pressure; follow up; hypertensive choroidopathy; retina detachment; wide field swept source optical coherence tomography angiography; clinical article; intracranial hypertension; visual impairment; female; human; blood pressure; optical coherence tomography angiography; visual acuity; multimodal imaging; anterior eye chamber; spectral domain optical coherence tomography; choroid disease; choroid capillary layer; choroidal thickness; adult; hypertension retinopathy; slit lamp microscopy
• ISSN: 2451-9936; 2451-9936
• DOI: 10.1016/j.ajoc.2019.01.001

To 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.
A 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.
In 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.