Increased choroidal blood flow and choroidal thickness in patients with hypertensive chorioretinopathy

Saito, Michiyuki; Noda, Kousuke; Saito, Wataru; Hirooka, Kiriko; Hashimoto, Yuki; Ishida, Susumu

doi:10.1007/s00417-019-04511-y

Cited by 28 publications

(38 citation statements)

References 23 publications

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“…These inflammatory diseases are theorized to be associated with choroidal infiltration of leukocytes causing flow obstruction due to adhesion of cells to the inner wall of vessels followed by compression from outside of vessels surrounded with extravasated cells. We have recently reported that hypertensive chorioretinopathy shows a circulatory hemodynamics similar to CSC [26]. The present case showed a low value of MBR from the onset, which was contrary to the non-inflammatory, hyperperfused pattern seen in CSC and hypertensive chorioretinopathy.…”

Section: Discussioncontrasting

confidence: 84%

Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

et al. 2020

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Background Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. Case presentation A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Conclusions Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.

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Section: Discussioncontrasting

confidence: 84%

Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

et al. 2020

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“…These three phases do not necessarily in this sequence. Choroid ischemia or choroidal hyperperfusion maybe play an important role in the pathogenesis of hypertensive chorioretinopathy, which develops because the automatic regulation ability of retinal vasculature cannot control the choroid vasculature [5][6][7] . Since hypertension was probably associated with lesions of retina and choroid, understanding the choroidal vascular abnormalities which resulted from elevation of blood pressure seems to be important.…”

Section: The Relationship Between Subfoveal Choroidal Thickness and Hmentioning

confidence: 99%

The relationship between Subfoveal Choroidal Thickness and Hypertensive Retinopathy

Shao

Zhou

et al. 2021

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The Beijing Eye Study 2011 is a population-based cross-sectional study in Northern China, which enrolled 3468 participants whose age were more than 50 years. A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography with enhanced depth imaging for measurement of SFCT and fundus photography. Blood pressure, fundus photographs and choroidal OCT-images were available for 3237 (93.3%) subjects, with 1953 (56.3 ± 0.8%) of the study population fulfilled the diagnosis of hypertension and 1089 subjects having hypertensive retinopathy. For the hypertensive cases, the SFCT in patients with hypertensive retinopathy (286.48 ± 105.23 µm) was significantly thicker than subjects without hypertensive retinopathy (187.04 ± 78.80 µm, P < 0.001). SFCT was significantly associated with the stage of hypertensive retinopathy (P < 0.001), but not significantly associated with diastolic blood pressure (P = 0.94), history (P = 0.95) and years (P = 0.91) of hypertension. In conclusion, hypertension as systemic disease was not significantly affect the subfoveal choroidal thickness, but as ocular disease, hypertensive retinopathy was significantly related to changes of choroidal thickness. Lesions of choroid during chronic hypertension may play an important role in development of hypertensive retinopathy.

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“…Acute hypertensive retinochoroidopathy is a very rare and severe ocular disease that results in a sharp decrease in vision associated to malignant hypertension and commonly occurring in young patients ( 1 ). Malignant hypertension is the most severe form of hypertension associated with preeclampsia, renal artery stenosis, and pheochromocytoma ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension is a risk factor for several systemic conditions that results in severe morbidity and mortality. It is also a risk indicator of vision-threatening ocular diseases, including hypertensive retinopathy, choroidopathy, and neuropathy ( 1 , 2 ). Malignant hypertension is the most severe form of hypertension, clinically defined as diastolic blood pressure above 130 mmHg.…”

Section: Introductionmentioning

confidence: 99%

Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report

et al. 2021

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Background: Acute hypertensive retinochoroidopathy is a rare, severe ocular disease, characterized by retinal and choroidal ischaemia. Untreated cases are associated with high mortality and poor visual outcomes. Patients subjected to treatment with the anti-neoplasic drug apatinib may trigger this disease. The purpose of this article is to describe in detail an acute hypertensive retinochoroidopathy in a young Chinese woman treated with apatinib.Case Presentation: A 40-year-old young Chinese woman presented a sudden but painless reduction of visual acuity in both eyes. She was previously diagnosed with gastric cancer and metastatic ovarian adenocarcinoma. The treatment consisted radical gastrectomy, transabdominal hysterectomy, bilateral adnexectomy, and 250 mg oral apatinib per day. After 58 days of apatinib administration, the patient immediately sought consult for a sudden decrease in vision. Her blood pressure was 208/136 mmHg and, based on the clinical manifestations, the patient was diagnosed with acute hypertensive retinochoroidopathy.Conclusions: This is the first case report of an apatinib-related acute hypertensive retinochoroidopathy diagnosed using fundal photograph, fundus fluorescein angiography, and spectral-domain optical coherence tomography simultaneously. It is crucial to develop a suitable strategy for management and prevention of this adverse event.

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Increased choroidal blood flow and choroidal thickness in patients with hypertensive chorioretinopathy

Cited by 28 publications

References 23 publications

Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

The relationship between Subfoveal Choroidal Thickness and Hypertensive Retinopathy

Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report

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