PDF(Pubmed)
Abstract：
BACKGROUND: We present a case of hypertensive choroidopathy due to malignant hypertension with exudative retinal detachment as a sole finding. We use OCT- angiography for initial diagnosis and report findings from extensive follow up.
METHODS: A 51-year-old female with no past medical history, presented to our clinic with painless loss of vision in her left eye. Fundus examination revealed only exudative retinal detachment in her left eye that was confirmed with Optical Coherence Tomography. Fluorescein angiography showed hyperfluorescent spots with leakage in late phases. OCTA manifested a focal dark area in the choriocapillaris slab corresponding to flow signal voids, signifying regions of non-perfusion. Her blood pressure was 220/120 mmHG. Complete blood work -up failed to reveal any other possible etiology. During follow-up period of 9 months blood pressure normalized, patient regained visual function and choriocapillaris perfusion was completely restored.
CONCLUSIONS: Hypertensive choroidopathy with exudative retinal detachment can be the only sign of malignant hypertension and no pre-existing history of a systemic disease is required in order to become apparent. OCTA reveals areas of non-perfusion at choriocapillaris level, proving that it is an essential tool in the diagnosis and follow up of patients with hypertensive choroidopathy. Finally, we propose that early diagnosis prevents permanent damage of the RPE and leads to complete choroidal remodeling and better visual outcomes.
METHODS: A 51-year-old female with no past medical history, presented to our clinic with painless loss of vision in her left eye. Fundus examination revealed only exudative retinal detachment in her left eye that was confirmed with Optical Coherence Tomography. Fluorescein angiography showed hyperfluorescent spots with leakage in late phases. OCTA manifested a focal dark area in the choriocapillaris slab corresponding to flow signal voids, signifying regions of non-perfusion. Her blood pressure was 220/120 mmHG. Complete blood work -up failed to reveal any other possible etiology. During follow-up period of 9 months blood pressure normalized, patient regained visual function and choriocapillaris perfusion was completely restored.
CONCLUSIONS: Hypertensive choroidopathy with exudative retinal detachment can be the only sign of malignant hypertension and no pre-existing history of a systemic disease is required in order to become apparent. OCTA reveals areas of non-perfusion at choriocapillaris level, proving that it is an essential tool in the diagnosis and follow up of patients with hypertensive choroidopathy. Finally, we propose that early diagnosis prevents permanent damage of the RPE and leads to complete choroidal remodeling and better visual outcomes.
摘要：
背景：我们介绍了一例恶性高血压引起的高血压脉络膜病变伴渗出性视网膜脱离的唯一发现。我们使用CT血管造影进行初步诊断，并报告广泛随访的发现。
方法：一名没有既往病史的51岁女性，她的左眼出现了无痛的视力丧失。眼底检查显示她的左眼仅渗出性视网膜脱离，经光学相干断层扫描证实。荧光素血管造影显示晚期有渗漏的高荧光斑点。OCTA表现出脉络膜毛细血管板中的局灶性暗区，对应于流量信号空隙。表示非灌注区域。她的血压是220/120mmHG。完整的血液检查未能揭示任何其他可能的病因。随访9个月血压恢复正常,患者恢复了视觉功能，脉络膜毛细血管灌注完全恢复。
结论：高血压脉络膜病伴渗出性视网膜脱离可能是恶性高血压的唯一征兆，并且不需要预先存在的全身性疾病史才能变得明显。OCTA揭示了脉络膜毛细血管水平的非灌注区域，证明它是诊断和随访高血压脉络膜病患者的重要工具。最后,我们建议早期诊断可防止RPE的永久性损伤,并导致脉络膜完全重塑和更好的视觉结局.
方法：一名没有既往病史的51岁女性，她的左眼出现了无痛的视力丧失。眼底检查显示她的左眼仅渗出性视网膜脱离，经光学相干断层扫描证实。荧光素血管造影显示晚期有渗漏的高荧光斑点。OCTA表现出脉络膜毛细血管板中的局灶性暗区，对应于流量信号空隙。表示非灌注区域。她的血压是220/120mmHG。完整的血液检查未能揭示任何其他可能的病因。随访9个月血压恢复正常,患者恢复了视觉功能，脉络膜毛细血管灌注完全恢复。
结论：高血压脉络膜病伴渗出性视网膜脱离可能是恶性高血压的唯一征兆，并且不需要预先存在的全身性疾病史才能变得明显。OCTA揭示了脉络膜毛细血管水平的非灌注区域，证明它是诊断和随访高血压脉络膜病患者的重要工具。最后,我们建议早期诊断可防止RPE的永久性损伤,并导致脉络膜完全重塑和更好的视觉结局.
