Pregnancy-induced hypertension-related chorioretinitis resembling uveal effusion syndrome

Abstract

Rationale:Pregnancy-induced hypertension (PIH) is a major cause of maternal and fetal mortality. Hypertensive choroidopathy is a preliminary sign of vasogenic edema in the choroid, and is associated with PIH. Here, we report a post-natal case of PIH-related chorioretinitis with bilateral severe serous retinal detachment (SRD) resembling uveal effusion syndrome.Patient concerns:A 35-year-old woman was diagnosed with severe PIH at 37 weeks of pregnancy. She underwent an emergency cesarean delivery. Four days after delivery, she perceived a sudden decrease of vision. At presentation, fundus examination demonstrated bullous SRD and multiple white mottles in the posterior poles of both eyes. Optical coherence tomography (OCT) showed macula edema and retinal pigment epithelium (RPE) folds. Indocyanine green angiography (ICGA) demonstrated delayed filling of choroidal circulation in the early phase and multiple hyperfluorescent spots in the mid phase.Diagnoses:PIH.Interventions:Antihypertension treatment alone resulted in gradual resolution of the SRD.Outcomes:At 463 days after delivery, fundus photographs of both eyes showed leopard spots corresponding to hyperautofluorescent spots with dark rim observed on fundus autofluorescence images.Lessons:Ophthalmologists should be aware of PIH-related chorioretinitis with similar clinical manifestations as uveal effusion syndrome, and should treat with antihypertensive agents in cooperation with obstetricians.

Case Report: Optical Coherence Tomography Can Find Typical Features in Pregnancy-induced Hypertension with Retinopathy

“…With fluorescein angiography, less or no choroidal fluorescence is seen. 4 The present study discusses the tiny changes in the outer retina and retinal pigmented epithelium as observed in patients with pregnancy-induced hypertension through spectral-domain optical coherence tomography.…”

“…These pathological abnormalities ultimately lead to fluid leakage and shallow retinal detachment. Sato and Takeuchi 4 believe that the multiple subretinal and epiretinal pigmented epithelium deposits with high brightness were proliferation and migration of the retinal pigmented epithelial cells as in uveal effusion syndrome. Similar to our case, these authors also state that malignant hypertension-induced ischemic retinal pigmented epithelial necrosis compromises the outer blood-retinal barrier leading to localized retinal pigmented epithelial detachment and serous retinal detachment.…”

“…3 Optical coherence tomography may help to find subretinal fluid, photoreceptor irregularities, and lesions at the retinal pigment epithelium level, all of which are features that are difficult to observe through fundus examination. 4…”

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

“…Severe hypertension can result in hypertensive retinopathy which can rarely manifest as hypertensive choroidopathy. Hypertensive choroidopathy is characterized by increased areas of choriocapillaris nonperfusion as well as exudative changes in the retina and presentation of Elschnig spots (characteristic black spots surrounded by yellow halos) (Rezkallah et al 2019;Saito et al 2018;Sato and Takeuchi 2018;Verstappen et al 2019). However, this severe retinopathy is not an aging-associated disease and can occur in young people or in cases of pregnancy-induced hypertension.…”

Effect of the drug combination of magnesium sulfate and phentolamine on homocysteine and c‑reactive protein in the serum of patients with pregnancy‑induced hypertension syndrome

“…Patient with serious conditions will die due to the massive haemorrhage appearing in enterocoelia (3). As the pathogenesis of pregnancy-induced hypertension syndrome is complex, its specific pathogenesis is still unclear in clinic, thus the treatment is difficult (4). Studies have pointed out that currently the preferred drug for the prevention and treatment of pregnancy-induced hypertension syndrome is magnesium sulfate (5).…”