Hypertension artérielle pulmonaire primitive familiale révélée par l’association bilatérale chémosis, myopisation et exophtalmie

Exudative retinal detachment and primary pulmonary hypertension

CASE REPORT

A 60 year old woman who was seen in the emergency department due to sudden loss of vision in left eye. The fundoscopy study showed exudative retinal detachment. The patient referred to dyspnea and peripheral edema of one year duration during the anamnesis. The systematic study revealed the existence of pulmonary hypertension, and she was given diuretic treatment (furosemide). After 48 h the detachment was resolved. Subsequent studies identified a primary pulmonary hypertension.

DISCUSSION

Exudative retinal detachment can be the first clinical sign of a serious disease like primary pulmonary hypertension. The ophthalmologist can be the first to detect this disease.

Flecked retina, choroidopathy, and retinal pigment epithelial tear in familial pulmonary arterial hypertension

BACKGROUND

Thanks to advancement in treatment modalities, the medial survival rate of patients with familial pulmonary arterial hypertension (FPAH) has been improved. Unfortunately, ocular complications because of the chronically elevated systemic venous pressure become more frequent.

METHODS

The authors report new FPAH-associated fundus changes in a 50-year-old male patient treated with sildenafil. The anomalies were studied with autofluorescence, fluorescein and indocyanine green angiography, and spectral optical coherence tomography including enhanced depth imaging.

RESULTS

Loss of vision and cystoid macular edema were associated with a flecked retina, a thick choroid, central serous choroidopathy-like changes in both eyes and with retinal pigment epithelium detachments and a retinal pigment epithelium tear in the right eye.

CONCLUSION

Treatment of ocular findings associated with FPAH mainly involves optimal control of pulmonary arterial hypertension and ophthalmic supportive treatment toward preventing acute ocular complications. The ocular complications occur as a result of enhanced pressure in the superior vena cava and in the ophthalmic veins, resulting in dilation of the ocular veins and congestion of the choroid. Sildenafil treatment in FPAH may enhance the congestion of the choroid and can induce central serous choroidopathy-like changes. A flecked retina, central serous choroidopathy-like changes, and retinal pigment epithelium tear are rare complications of FPAH.

[Ocular manifestations of primary pulmonary artery hypertension]

INTRODUCTION

To report two patients with primary pulmonary hypertension (PPH) and associated ocular findings.

CASE REPORT

Two men, 54 and 50 years old, were referred for primary pulmonary hypertension: one patient had had a double-lung transplantation a month before and noticed pain and decreased vision in the right eye; the other man was waiting for a lung transplant and noticed decreased vision in the left eye. Both patients presented with a dilatation of the conjunctival and episcleral veins, without glaucoma, and with bilateral chronic choroidal ischemia. One patient underwent a fluorescein angiography examination and indocyanine green videoangiography.

CONCLUSION

Elevated venous pressure is responsible for the dilatation of the conjunctival and episcleral veins, sometimes associated with glaucoma, and for chronic choroidal ischemia with a decrease in visual acuity. Other clinical pictures are discussed.