Changes in choroidal circulation and pulse waveform in a case of pregnancy-induced hypertension with serous retinal detachment

Abstract

Purpose We aimed to examine the changes in choroidal blood flow (CBF), choroidal pulse waveform, and central choroidal thickness (CCT) in a case of pregnancy-induced hypertension (PIH) using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) before and after treatment with antihypertensive drugs. Observations A 24-year-old Japanese woman diagnosed with PIH presented with complaints of worsening and blurred vision in the right eye. Funduscopic findings at the initial visit showed serous retinal detachment (SRD), retinal hemorrhage, and arterial tortuosity. The LSFG color map showed a warm color. Macular mean blur rate (MBR), which is an index of relative blood flow velocity, in both eyes was high, along with choroidal thickening. Blowout time (BOT), which indicates the rate of time in which the MBR is greater than half the amplitude during one heartbeat, was low and acceleration time index (ATI), which represents the time-to-peak of MBR, was high. Several weeks after treatment with antihypertensive drugs, the CBF and ATI gradually decreased with regression of the SRD and thinning of the CCT. On the other hand, BOT gradually increased after treatment, showing a significant decrease in vascular resistance. Ocular perfusion pressure decreased after treatment because of the reduction in blood pressure. Conclusions and Importance LSFG might reveal choroidal overperfusion and increased vascular resistance, along with SRD and choroidal thickening, in a patient with PIH with reversal after treatment with antihypertensive drugs. These findings demonstrate the importance of evaluation of ocular blood flow and vascular resistance in women with PIH in order to routinely assess the clinical and systemic condition.

Quantitative analysis of choroidal morphology in preeclampsia during pregnancy according to retinal change

“…Previously, Azuma et al reported that a larger choroidal luminal area was associated with a higher systolic BP in pregnancy 13 . Choroidal overperfusion and increased vascular resistance in a pregnancy-induced hypertension patients with SRD had been demonstrated using laser speckle flowgraphy 14 . Also, SRD was associated with thicker CT in the current study.…”

Changes in Choroidal Thickness and Structure in Preeclampsia with Serous Retinal Detachment

“…Until recently, it was considered that hypertensive choroidopathy is caused by constriction of choroidal arterioles and impaired choroidal blood flow [ 4 , 6 ]. However, the findings in previous reports in which laser speckle flowgraphy (LSFG) was used showed that increased choroidal blood flow velocity correlated with choroidal thickening in patients with hypertensive choroidopathy, thus suggesting that choroidal hyperperfusion may be involved in hypertensive choroidopathy [ 7 , 8 , 35 ]. Those results are consistent with the increased CVI in this present study, and in particular, the increased blood flow in the choroidal outer layer may have contributed to it.…”

Reduced blood flow by laser speckle flowgraphy after 125I-plaque brachytherapy for uveal melanoma

“…Its output parameter, mean blur rate (MBR), is linearly proportional to relative blood flow velocity at each pixel imaged by a video camera sensor. LSFG is an established method of detecting blood flow variations in ocular disorders such as glaucoma [ 17 ] and ischemic optic neuropathy [ 18 ], as well as systemic conditions such as hypertension [ 19 ] and metabolic syndrome [ 20 ]. Here, we deployed LSFG to test whether reductions in blood flow velocity could be detected in patients at various time points after treatment with 125 I-plaque brachytherapy.…”