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Hao S, Hao W, Ma Y. The features of serous retinal detachment in preeclampsia viewed on spectral-domain optical coherence tomography. Pregnancy Hypertens 2024; 36:101117. [PMID: 38428345 DOI: 10.1016/j.preghy.2024.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/01/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To evaluate the characteristics of serous retinal detachment on spectral-domain optical coherence tomography in preeclampsia. METHODS In this retrospective case-series study, clinical characteristics of retinal damage were evaluated using spectral-domain optical coherence tomography (SD-OCT) imaging. RESULTS Thirty affected eyes from 16 pregnant women with preeclampsia were included. The features of serous retinal detachment, observed using SD-OCT, consisted of lesions located in the macular or peripapillary region; the presence of intraretinal or subretinal fluid (intraretinal fluid, IRF; subretinal fluid, SRF); ellipsoid zone integrity (normal/abnormal); intraretinal hyper-reflective dots; and Elschnig spots (retinal pigment epithelium lesions). Of the 30 affected eyes, 25 (83.33%) had lesions located in the macular region, 19 (63.33%) outside the macula (in the peripapillary region), and 14 (46.67%) in both. SD-OCT showed IRF in 2 eyes (6.67%), SRF in 30 eyes (100.00%), and both in 2 eyes (6.67%). The ellipsoid zone was disrupted in 20 eyes (66.67%), intraretinal hyper-reflective dots were observed in 4 eyes (13.33%), and Elschnig spots were observed in 20 eyes (66.67%). CONCLUSION Spectral-domain optical coherence tomography is a non-invasive, reliable imaging tool for the assessment of retinal pathologies in preeclampsia.
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Affiliation(s)
- Shengli Hao
- Department of Ophthalmology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Orbital Disease, Tianjin, 300211, China
| | - Weiting Hao
- Department of Ophthalmology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Orbital Disease, Tianjin, 300211, China.
| | - Yao Ma
- Department of Ophthalmology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Orbital Disease, Tianjin, 300211, China
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Soullane S, Rhéaume MA, Auger N. Preeclampsia and the Retina. Curr Hypertens Rep 2024; 26:169-174. [PMID: 38133842 DOI: 10.1007/s11906-023-01290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes key findings relating to the association between preeclampsia and retinal disorders. RECENT FINDINGS Preeclampsia is a major cause of maternal morbidity. Pregnant women with preeclampsia frequently describe having visual disturbances. Retinal changes can be identified on fundoscopy in most patients with preeclampsia. While retinal pathology secondary to preeclampsia usually resolves postpartum, there is growing evidence that women with preeclampsia have a higher long-term risk of developing retinal disorders after pregnancy. Pregnant women often experience visual changes. While these symptoms may be benign, careful attention should be paid to exclude retinal disorders secondary to preeclampsia. Pregnant women complaining of new-onset or worsening blurry vision, scotomata, diplopia, or photopsia require rapid and thorough evaluation to rule out hypertensive disorders. Management of preeclampsia, including administration of magnesium sulfate and delivery of the fetus, can reverse retinal pathologies in most cases.
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Affiliation(s)
- Safiya Soullane
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Marc-André Rhéaume
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Department of Ophthalmology, University of Montreal, Montreal, QC, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
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Valderrama-Albino V, Loayza-Gamboa W, Campos-Dávila B, Quispe-Ramírez A, Arenas-Canchuja F, Valera-Cornejo D. Chorioretinal Findings in a Patient with New-Onset Systemic Lupus Erythematosus and Antiphospholipid Syndrome after Stillbirth Associated with Pre eclampsia. Ocul Immunol Inflamm 2024; 32:295-300. [PMID: 36800519 DOI: 10.1080/09273948.2023.2168699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE To describe chorioretinal findings in a patient with new-onset systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) after a stillbirth associated with preeclampsia. STUDY DESIGN Case report. RESULTS We report a patient with new-onset SLE and APS after pregnancy, who had a history of preeclampsia and intrauterine death that presented with bilateral visual loss after a seizure. Clinical findings of a unilateral vaso-occlusive retinopathy and choroidopathy associated with intraocular inflammation, serous retinal detachment, and vasculitis are presented, which responded well to immunosuppressive therapy. CONCLUSION New-onset systemic lupus erythematosus (SLE) during or after pregnancy could occur, especially when complicated with preeclampsia, making it difficult to diagnose accurately. Pregnancy-induced hypertension retinopathy and choroidopathy, as well as chorioretinal manifestations of SLE and APS, can share similar ocular manifestations that can overlap and coexist in the same patient, and it is important to recognize them for an adequate management and follow-up.
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Affiliation(s)
| | | | - Betty Campos-Dávila
- Uvea Department, National Institute of Ophthalmology, "Dr. Francisco Contreras Campos", Lima, Perú
| | - Alejandra Quispe-Ramírez
- Ophthalmology Residency in National Institute of Ophthalmology, "Dr. Francisco Contreras Campos", Lima, Perú
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Sivakumaran P, Khare M, Kumar P. A Case Report of Bilateral Exudative Retinal Detachment in Severe Pre-eclampsia. Cureus 2024; 16:e56791. [PMID: 38650803 PMCID: PMC11034995 DOI: 10.7759/cureus.56791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
We report a case of a 31-year-old gravida 2 para 1 female presenting to the optician with a two-week history of blurred vision and persistent headaches at 29 weeks gestation. Visual acuity on presentation was 6/100 in the right eye and 6/24 in the left eye. Fundoscopy of both eyes revealed serous retinal detachment in the absence of background retinal changes. On urgent admission to the maternity assessment unit, blood pressure was 189/126 mmHg and urine dipstick revealed 4+ proteinuria. Due to recurrent poor foetal heart rate variability on cardiotocography monitoring, an emergency caesarean was conducted. Sixteen hours following delivery, visual symptoms had improved, and clinical examination revealed normal blood pressure. An optical coherence tomography scan performed three months later was dry bilaterally with minor retinal pigment epithelium clumping. Serous retinal detachment involves the separation of the neurosensory retinal layer from the underlying retinal pigment epithelium. It is rare in pre-eclampsia but can be seen in patients with severe disease. The presentation of serous retinal detachment includes acute visual loss, reduced visual acuity, floaters, and flashing lights appearing in the vision. Although alarming on initial presentation, resolution is commonly seen within a couple of days postpartum. The pathogenic mechanism for serous retinal detachment development is widely discussed and thought to include changes to the choroidal circulation. Overall, although often self-resolving, a move to thorough antenatal care and vigilant monitoring in pre-eclamptic women is vital to prevent complications like this from occurring.
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Affiliation(s)
| | - Manjiri Khare
- Maternal-Fetal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Periyasamy Kumar
- Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Karasu B, Kesim E, Celebi ARC. The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome. Eur J Ophthalmol 2024; 34:510-523. [PMID: 37408434 DOI: 10.1177/11206721231185909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS). DESIGN Retrospective cohort, comparative study. METHODS AND MATERIALS The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit. RESULTS Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032). CONCLUSION All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.
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Affiliation(s)
- Buğra Karasu
- Tuzla Public Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Enes Kesim
- Tuzla Public Hospital, Department of Ophthalmology, Istanbul, Turkey
- Okan University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- Acibadem University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
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Wang L, Suo L, Kou F, Zhang Y, Li M, Wang H, Casalino G, Peto T, Chakravarthy U, Wang Y, Wu W, Dong N. Ocular Phenotypes in Patients With Hemophagocytic Lymphohistiocytosis: A Retrospective Analysis in a Single Center Over 7 Years. Am J Ophthalmol 2023; 253:119-131. [PMID: 37178948 DOI: 10.1016/j.ajo.2023.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To investigate the presence and type of ocular abnormalities in patients with hemophagocytic lymphohistiocytosis (HLH). DESIGN A retrospective cross-sectional study. METHODS Observational report of ocular findings and their associations with age, sex, underlying disease, and hematologic parameters. HLH was defined according to the 2004 criteria, and the patients were enrolled from March 2013 to December 2021. Analysis began in July 2022 and ended in January 2023. The main outcome measures were ocular abnormalities associated with HLH and their potential risk factors. RESULTS Of 1525 HLH patients, 341 had ocular examinations, and 133 (133 of 341, 39.00%) had ocular abnormalities. Mean age at presentation was 30.21 ± 14.42 years. The multivariate analysis indicated that old age, autoimmune disorders, decreasing red blood cell count, decreasing platelet count, and increasing fibrinogen level were independent risk factors of ocular involvement in HLH patients. The most common presenting ocular findings were posterior segment abnormalities (66 patients, 49.62%), including retinal and vitreous hemorrhage, serous retinal detachment, cytomegalovirus retinitis, and optic disc swelling. Other HLH-associated ocular abnormalities included ocular surface infection (conjunctivitis, 34 patients, 25.56%; keratitis, 16 patients, 12.03%), subconjunctival hemorrhage (11 patients, 8.27%), chemosis (5 patients, 3.76%), anterior uveitis (11 patients, 8.27%), glucocorticoid-induced glaucoma (5 patients, 3.76%), radiation cataract (1 patient, 0.75%), dacryoadenitis (2 patients, 1.50%), dacryocystitis (1 patients, 0.75%), orbital cellulitis (2 patients, 1.50%), orbital pseudotumor (2 patients, 1.50%), and strabismus (2 patients, 1.50%). CONCLUSIONS Eye involvement is not uncommon in HLH. Better awareness among both ophthalmologists and hematologists is necessary for prompt diagnosis and institution of appropriate management strategies with potential to save sight and life.
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Affiliation(s)
- Luping Wang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Lingge Suo
- Department of Ophthalmology, Peking University Third Hospital (L.S.), Beijing, China; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital (L.S.), Beijing, China
| | - Fangning Kou
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University (F.K.), Beijing, China
| | - Youjing Zhang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Mingming Li
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Hao Wang
- Department of Clinical Epidemiology and Evidence-Based Medicine, Beijing Clinical Research Institute, Beijing Friendship Hospital, Capital Medical University (H.W.), Beijing, China
| | - Giuseppe Casalino
- Eye Clinic, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan (G.C.), Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University of Belfast (T.P., U.C.), Belfast, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University of Belfast (T.P., U.C.), Belfast, United Kingdom
| | - Yanling Wang
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Weizhen Wu
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China
| | - Ning Dong
- From the Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University (L.W., Y.Z., M.L., Y.W., W.W., N.D.), Beijing, China.
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Kim IK, Shin JE, Kim MJ, Ra H, Baek J. Quantitative analysis of choroidal morphology in preeclampsia during pregnancy according to retinal change. Sci Rep 2023; 13:13171. [PMID: 37580383 PMCID: PMC10425443 DOI: 10.1038/s41598-023-40144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
We sought to investigate changes in choroidal hemodynamics in preeclampsia according to presence of retinal change by quantitatively assessing choroidal vessels using optical coherence tomography (OCT). This retrospective study included 106 eyes (of 53 patients) with preeclampsia, including 70 eyes without retinal change in patients with preeclampsia (Group A), 22 eyes with retinal change in patients with preeclampsia (Group B), and 14 eyes of normal pregnant women (controls). Subfoveal choroidal thickness (SFCT) was measured on OCT B-scan images, and choroidal vessel densities (CVDs) were calculated using binarized OCT B-scan and en face images. Their values were then correlated with clinical parameters associated with preeclampsia. SFCT was greater in Group B compared to Group A or controls (354.32 ± 65.13 vs. 288 ± 55.68 or 277.21 ± 50.08, both P < 0.001). CVD on B-scan images was greater in Group B compared to Group A or controls (76.4 ± 4.9 vs. 73.7 ± 5.3 or 71.5 ± 5.1; both P ≤ 0.046). CVD on en face images was also greater in Group B compared to Group A or controls (64.7 ± 0.8 vs. 63.6 ± 1.5 or 63.3 ± 1.3; both P ≤ 0.001). SFCT and CVD positively correlated with each other (P ≤ 0.009) and were greater in patients with blurred vision and vaginal bleeding (P ≤ 0.020 for blurred vision and P ≤ 0.024 for vaginal bleeding). SFCT and CVDs were higher in preeclampsia patients with retinal change compared to those without retinal change or controls. Both SFCT and CVD showed association with blurred vision and vaginal bleeding.
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Affiliation(s)
- In Kee Kim
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea
| | - Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-Do, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jeong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-Do, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Ra
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiwon Baek
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea.
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Karagiannis D, Bouratzis N, Kontomichos L, Pantazis P, Kandarakis S, Paroikakis E. Unilateral hypertensive choroidopathy as a sole manifestation in malignant hypertension: optical coherence tomography angiography findings-case report. BMC Ophthalmol 2023; 23:227. [PMID: 37211613 DOI: 10.1186/s12886-023-02970-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 05/09/2023] [Indexed: 05/23/2023] Open
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. CASE PRESENTATION 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. DISCUSSIONS AND 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.
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Affiliation(s)
- Dimitrios Karagiannis
- Second Department of Ophthalmology, Ophthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - Nikolaos Bouratzis
- Second Department of Ophthalmology, Ophthalmiatreion Eye Hospital of Athens, Athens, Greece.
| | - Loukas Kontomichos
- Second Department of Ophthalmology, Ophthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - Panagiotis Pantazis
- Second Department of Ophthalmology, Ophthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - Stylianos Kandarakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Efstratios Paroikakis
- Second Department of Ophthalmology, Ophthalmiatreion Eye Hospital of Athens, Athens, Greece
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Munsell MK, Carducci NM, Eton EA. Exudative Retinal Detachment and Ciliochoroidal Effusion in Preeclampsia. JOURNAL OF VITREORETINAL DISEASES 2023; 7:254-258. [PMID: 37188210 PMCID: PMC10170621 DOI: 10.1177/24741264221147986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To describe a novel case of focal exudative retinal detachment, choroidal effusion, and acute angle closure in preeclampsia. Methods: A case report is presented. Results: A 37-year-old woman at 38 weeks gestation presented with 2 weeks of progressive blurred vision in the left eye. She had a visual acuity (VA) of 20/800 and an intraocular pressure (IOP) of 26 mm Hg in the left eye (compared with 17 mm Hg in the right eye). Examination showed subretinal fluid in the posterior pole, ciliochoroidal effusion, and angle closure in the left eye without pathology in the right eye. She was found to have hypertension and proteinuria consistent with preeclampsia. The visual symptoms resolved after delivery. At the 1-month follow-up, she had a VA of 20/60 OS, symmetric IOPs, and resolved subretinal and choroidal effusions. Conclusions: To our knowledge, this is the first reported case of ciliochoroidal effusion in the setting of preeclampsia. It may aid in the diagnosis of preeclampsia's ocular manifestations and broaden pathophysiological understanding.
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Affiliation(s)
- Mary K. Munsell
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas M. Carducci
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Emily A. Eton
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
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10
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Santoro JM, Jeng-Miller KW, Liang MC. BILATERAL SEROUS RETINAL DETACHMENTS IN A PATIENT WITH PREECLAMPSIA WITHOUT HYPERTENSION. Retin Cases Brief Rep 2023; 17:219-223. [PMID: 33743521 DOI: 10.1097/icb.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a case of bilateral serous retinal detachments in a patient with preeclampsia without hypertension using multimodal ophthalmic imaging. METHODS Case report. RESULTS This case demonstrates the rare presentation of bilateral serous retinal detachment in a patient with preeclampsia without hypertension. Characteristic subretinal fluid was seen on examination and optical coherence tomography. No leakage was noted on fluorescein angiography. Treatment was deferred, and the subretinal fluid resolved within 3 weeks. CONCLUSION Practitioners should be aware of the rare presentation of serous retinal detachments in preeclampsia, even in the absence of hypertension. Long-term sequelae are uncommon and usually only seen in severe disease. Delivery should be considered once serous retinal detachment develops.
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Affiliation(s)
- Jarod M Santoro
- Retina Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | - Karen W Jeng-Miller
- Retina Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
- Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Michelle C Liang
- Retina Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
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11
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Arévalo Simental DE, Sepulveda Tinajero LH, Villarreal Contreras FA, Becerra Cota MG, Ingolotti M. MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE. Retin Cases Brief Rep 2023; 17:33-36. [PMID: 36525246 DOI: 10.1097/icb.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease. METHODS Observational case report. RESULTS An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes. CONCLUSION Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.
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12
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[Serous retinal detachment after cesarean section]. DIE OPHTHALMOLOGIE 2023; 120:82-85. [PMID: 35312835 DOI: 10.1007/s00347-022-01611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023]
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13
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Fayed AE, Thabet MM, Salama MM, El Shazly M. Diminished choroidal blood flow in hypertensive and preeclamptic third trimester pregnancies using optical coherence tomography angiography. PLoS One 2023; 18:e0285884. [PMID: 37200272 DOI: 10.1371/journal.pone.0285884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE The aim of this study was to compare choroidal adjusted flow index (AFI) in healthy, hypertensive & preeclamptic pregnancies using optical coherence tomography angiography (OCTA). METHODS In this prospective study, healthy, hypertensive & preeclamptic third trimester pregnant women underwent OCTA imaging. 3x3 & 6x6 mm choriocapillaris slabs were exported and the parafoveal area was marked by two concentric ETDRS circles at 1 & 3 mm, centered on the foveal avascular zone. Parafoveal AFI was calculated as a parameter of choroidal blood flow. RESULTS Fifteen eyes of fifteen women per group were recruited (45 eyes). AFI was significantly lower in the preeclamptic compared to the healthy & hypertensive groups (Tukey HSD: <0.001 in both groups on 3x3 mm, and 0.02 & 0.04 in 6x6 mm scans), and in the hypertensive compared to the healthy group (0.005 & 0.03 in 3x3 & 6x6 mm scans respectively). CONCLUSIONS Pregnancies complicated with preeclampsia revealed the lowest choroidal blood flow on OCTA followed by pregnancies with systemic hypertension compared to healthy pregnancies. We provide in-vivo documentation of choroidal ischemia, highlighting its culpability in hypertensive and preeclamptic retinochoroidal pathology, and the possibility of utilizing choroidal blood flow on OCTA as a precursor for disease progression.
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Affiliation(s)
- Alaa E Fayed
- Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt
- Watany Research & Development Center, Watany Eye Hospital, Cairo, Egypt
| | - Mohamed M Thabet
- Department of Obstetrics and Gynecology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt
| | - Marwa Metwally Salama
- Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt
| | - Malak El Shazly
- Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt
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14
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Carreño E, Pichi F, Agarwal A, Munk MR. Comment on "SUN Classification Criteria for Vogt-Koyanagi-Harada Disease". Am J Ophthalmol 2022; 244:228-229. [PMID: 35940245 DOI: 10.1016/j.ajo.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Ester Carreño
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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15
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Wiedemann J, Altay L, Neugebauer A, Krohne T, Cursiefen C. Visual complaints in pregnancy: (pre)eclampsia as a chameleon. GMS OPHTHALMOLOGY CASES 2022; 12:Doc21. [PMID: 36569356 PMCID: PMC9762176 DOI: 10.3205/oc000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective The visual system often is affected in patients with preeclampsia and even more in cases of eclampsia, a life-threatening pregnancy complication. Symptoms include blurred vision and deterioration of visual acuity. Pregnancy can also affect pre-existing conditions, such as diabetic retinopathy. In this case series, we describe three patients with the same underlying condition, i.e. (pre)eclampsia who experienced acute visual disturbance whereas the final diagnosis was different: disseminated intravascular coagulopathy (DIC), posterior reversible encephalopathy syndrome (PRES), and diabetic retinopathy. Methods and results All patients underwent a thorough slit lamp examination and ocular coherence tomography (OCT). All patients presented with acute impaired vision and subretinal fluid and-/or fibrin. Conclusions These cases highlight the importance of early involvement of ophthalmologists when pregnant women complain about visual disorders.
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Affiliation(s)
- Johanna Wiedemann
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany,*To whom correspondence should be addressed: Johanna Wiedemann, Department of Ophthalmology and Eye Hospital, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany, E-mail:
| | - Lebriz Altay
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Antje Neugebauer
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Tim Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Germany
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16
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Mishra P, Dash N, Sahu SK, Kanaujia V, Sharma K. Malignant Hypertension and the Role of Ophthalmologists: A Review Article. Cureus 2022; 14:e27140. [PMID: 36017304 PMCID: PMC9392986 DOI: 10.7759/cureus.27140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient’s life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.
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17
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Hsu YR, Wang LU, Chen FT, Wang JK, Huang TL, Chang PY, Chen YJ. Clinical Manifestations and Implications of Nonneoplastic Uveitis Masquerade Syndrome. Am J Ophthalmol 2022; 238:75-85. [PMID: 34995524 DOI: 10.1016/j.ajo.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the clinical manifestations and systemic and ocular implications of nonneoplastic uveitis masquerade syndrome (NNUMS). DESIGN Retrospective case series. METHODS The clinical data of 830 consecutive patients who presented with uveitis at a tertiary referral center in northern Taiwan between August 2013 and August 2020 were analyzed. The clinical characteristics and outcomes of patients with NNUMS were evaluated. RESULTS Overall, 3.7% of patients were determined to have uveitis masquerade syndrome. Among them, 24 patients (77%; 34 eyes) were diagnosed as having NNUMS. The main presenting anatomical location was posterior uveitis (58.8%). In the NNUMS group, a high chorioretinal involvement rate (94.1%) and delayed diagnosis from symptom onset (45.8% cases were diagnosed after more than 90 days) were found. Multimodal imaging was the major decisive diagnostic factor. Systemic condition alterations requiring urgent treatment were noted in 29.2% of cases. Ocular complications were noted in 58.8% of cases; 60% of those were observed on referral. Following appropriate treatment, visual acuity could be maintained in 88.3% of cases. The 5 major categories of NNUMS were retinal vascular disorders, rhegmatogenous retinal detachment, retinal dystrophy, central serous chorioretinopathy, and uveal effusion syndrome. CONCLUSION NNUMS is a group of heterogeneous diseases with a complex diagnostic process and significant ocular and systemic effects. High awareness regarding common clinical manifestations is crucial for physicians to make the appropriate diagnosis and management.
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18
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Preeclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol 2022; 226:S786-S803. [PMID: 35177220 PMCID: PMC8941666 DOI: 10.1016/j.ajog.2021.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
Preeclampsia, one of the most enigmatic complications of pregnancy, is considered a pregnancy-specific disorder caused by the placenta and cured only by delivery. This article traces the condition from its origins-once thought to be a disease of the central nervous system, recognized by the occurrence of seizures (ie, eclampsia)-to the present time when preeclampsia is conceptualized primarily as a vascular disorder. We review the epidemiologic data that led to the recommendation to use diastolic hypertension and proteinuria as diagnostic criteria, as their combined presence was associated with an increased risk of fetal death and the birth of small-for-gestational-age neonates. However, preeclampsia is a multisystemic disorder with protean manifestations, and the condition can be present even in the absence of hypertension and proteinuria. Toxins gaining access to the maternal circulation have been proposed to mediate the clinical manifestations-hence, the term "toxemia of pregnancy," which was used for several decades. The search for putative toxins has challenged investigators for more than a century, and a growing body of evidence suggests that products of an ischemic or a stressed placenta are responsible for the vascular changes that characterize this syndrome. The discovery that the placenta can produce antiangiogenic factors, which regulate endothelial cell function and induce intravascular inflammation, has been a major step forward in the understanding of preeclampsia. We view the release of antiangiogenic factors by the placenta as an adaptive response to improve uterine perfusion by modulating endothelial function and maternal cardiovascular performance. However, this homeostatic response can become maladaptive and lead to damage of target organs during pregnancy or the postpartum period. Early-onset preeclampsia has many features in common with atherosclerosis, whereas late-onset preeclampsia seems to result from a mismatch of fetal demands and maternal supply, that is, a metabolic crisis. Preeclampsia, as it is understood today, is essentially vascular dysfunction unmasked or caused by pregnancy. A subset of patients diagnosed with preeclampsia are at greater risk of the subsequent development of hypertension, ischemic heart disease, heart failure, vascular dementia, and end-stage renal disease. However, these adverse events may be the result of a preexisting vascular pathologic process; it is not known if the occurrence of preeclampsia increases the baseline risk. Therefore, the understanding, prediction, prevention, and treatment of preeclampsia are healthcare priorities.
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19
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Moss HE. Neuro-ophthalmology and Pregnancy. Continuum (Minneap Minn) 2022; 28:147-161. [PMID: 35133315 PMCID: PMC9159902 DOI: 10.1212/con.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This article summarizes the impact of pregnancy on neuro-ophthalmic pathways and presents an approach to the evaluation of pregnant women who have neuro-ophthalmic symptoms or signs. RECENT FINDINGS Advances in noninvasive ophthalmic imaging have increased knowledge of the impact of pregnancy on ocular blood flow, which may have relevance for understanding the impact of preeclampsia and eclampsia on the eye. SUMMARY The framework for approaching neuro-ophthalmic symptoms and signs in pregnant women is similar to the general approach for people who are not pregnant. Visual symptoms are common in preeclampsia and eclampsia. Some diseases that impact the neuro-ophthalmic pathways are more common in pregnant women. Pregnancy should be considered when recommending the workup and treatment for neuro-ophthalmic symptoms and signs.
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20
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Tan W, Yao X, Le TT, Tan ACS, Cheung CY, Chin CWL, Schmetterer L, Chua J. The Application of Optical Coherence Tomography Angiography in Systemic Hypertension: A Meta-Analysis. Front Med (Lausanne) 2021; 8:778330. [PMID: 34859021 PMCID: PMC8630630 DOI: 10.3389/fmed.2021.778330] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/20/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Multiple studies have compared various optical coherence tomography angiography (OCTA) parameters in participants with systemic hypertension vs. controls and have presented discordant findings. We conducted a meta-analysis to pool together data from different studies to generate an overall effect size and find out whether OCTA parameter(s) significantly differed in participants with systemic hypertension as compared to controls. Methods: We conducted a literature search through a search of electronic databases to identify studies before 19 June 2021, which compared OCTA parameters in non-diabetic participants with systemic hypertension vs. controls. If the OCTA parameter had a minimum number of 3 studies that analyzed it, the mean difference between participants with systemic hypertension and controls were analyzed using a random-effects model. Results: We identified 11 eligible studies. At the macula, 9 studies analyzed vessel density at the superficial capillary plexus (SVD), 7 analyzed vessel density at the deep capillary plexus (DVD), and 6 analyzed the area of the superficial foveal avascular zone (FAZ). Participants with systemic hypertension had significantly lower SVD (standardized mean difference [SMD], -0.50 [-0.70, -0.30], P < 0.00001, I 2 = 63%), lower DVD (SMD, -0.38 [-0.64, -0.13], P = 0.004, I 2 = 67%) and larger superficial FAZ (SMD, 0.32 [0.04, 0.61], P = 0.020, I 2 = 77%). Conclusion: The eyes of people with systemic hypertension have robustly lower superficial and deep vascular densities at the macula when compared to control eyes. Our results suggest that OCTA can provide information about pre-clinical microvascular changes from systemic hypertension.
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Affiliation(s)
- Wilson Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Thu-Thao Le
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Anna C S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Calvin Woon Loong Chin
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
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21
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Yao B, Liu G, Wang B, Cao Q. Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report. Front Med (Lausanne) 2021; 8:677941. [PMID: 34249970 PMCID: PMC8260843 DOI: 10.3389/fmed.2021.677941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, China
| | - Gang Liu
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, China
| | - Bei Wang
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, China
| | - Qian Cao
- Department of Ophthalmology, General Hospital of Eastern Theater Command, Nanjing, China
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23
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de Nattes T, Saad R, Buob D, Verney C, Doreille A, Luque Y, Mesnard L, Pâques M, Rafat C. Retinal Arteriolar Occlusions and Exudative Retinal Detachments in Malignant Hypertension: More Than Meets the Eye. Am J Hypertens 2021; 34:30-33. [PMID: 32840289 DOI: 10.1093/ajh/hpaa138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies between the posterior pole of the eye and the kidney, ophthalmological explorations may inform clinicians on the mechanisms underpinning concurrent kidney injury in this condition. More specifically, we investigated whether the wall-to-lumen ratio (WLR) of retinal arterioles measured by adaptive optics ophthalmoscopy could be correlated to WLR of kidney arterioles as determined by pathology. We sought to estimate the incidence of retinal arteriole occlusion a supposedly uncommon complication of malignant hypertension. METHODS All patients hospitalized in our renal Intensive Care Unit for malignant hypertension between 2016 and 2019 were referred to ophthalmological examinations. RESULTS Twenty-seven patients were included. Median retinal WLR was 0.39 [0.31-0.47] and was correlated with initial systolic (r = 0.56, P = 0.003) and mean blood pressure (r = 0.46, P = 0.02) upon admission. The retinal WLR was not correlated to renal pathological findings, as assessed by juxtaglomerular WLR (r = 0.38, P = 0.2), ratio of glomerulosclerosis (r = -0.39, P = 0.2), or tubulointerstitial fibrosis (r = -0.45, P = 0.08). Retinal WLR was not associated with neurological or cardiovascular end-organ damage. Branch retinal artery occlusion was detected in 18.5% of patients and exudative retinal detachment (ERD) in 29.6% of patients, without any significant correlation with canonical signs of retinal hypertension including optic disc swelling. CONCLUSIONS In the setting of malignant hypertension, we failed to demonstrate a significant relationship between WLR and other meaningful end-organ injuries. However, branch retinal artery occlusion and ERD may have been hitherto underestimated.
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Affiliation(s)
- Tristan de Nattes
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
- Nephrology—Kidney Transplant Unit, Rouen University Hospital, Rouen, France
| | - Rana Saad
- Department of Ophthalmology, PARIS Group, Quinze-Vingts Hospital, Paris, France
- Institut hospitalo-universitaire FOReSIGHT, Hôpital des Quinze-Vingts, Paris, France
| | - David Buob
- Pathology Department, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charles Verney
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Alice Doreille
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Laurent Mesnard
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Michel Pâques
- Department of Ophthalmology, PARIS Group, Quinze-Vingts Hospital, Paris, France
- Institut hospitalo-universitaire FOReSIGHT, Hôpital des Quinze-Vingts, Paris, France
| | - Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
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24
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Otero-Marquez O, Chung H, Lee CS, Choi EY, Ledesma-Gil G, Alauddin S, Lee M, Bhuiyan A, Smith RT. Subretinal Deposits in Pre-eclampsia and Malignant Hypertension: Implications for Age-Related Macular Degeneration. Ophthalmol Retina 2020; 5:750-760. [PMID: 33130003 DOI: 10.1016/j.oret.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the incidence of subretinal deposits that are similar in structure and stage on OCT imaging to subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension (MHT) and the implications of this ischemic choroidopathy for the pathophysiologic characteristics of SDDs in AMD. DESIGN Retrospective cross-sectional study. PARTICIPANTS Thirty-three pre-eclampsia patients and 25 MHT patients with serous retinal detachment (SRD) in at least 1 eye were included. METHODS Serial multimodal images, including enhanced depth imaging spectral-domain OCT of eyes with hypertensive choroidopathy secondary to pre-eclampsia and MHT, were reviewed at 2 time points, the acute phase (within 4 weeks of initial hypertensive insult) and the recovery phase (beyond 4 weeks). MAIN OUTCOME MEASURES Incidence of SDD-like lesions in patients with hypertensive choroidopathy secondary to pre-eclampsia and MHT. RESULTS Subretinal drusenoid deposit-like lesions were observed exclusively in eyes with SRD. Serous retinal detachment occurred in 87.87% of eyes of pre-eclampsia patients and in 94% of eyes of MHT patients. Subretinal drusenoid deposit-like lesions occurred in 28.57% of all eyes with SRD, in 32.76% of eyes with SRD from the pre-eclampsia group, and in 23.40% of eyes with SRD from the MHT group. Vascular imaging suggested underlying choroidal ischemia in all patients (12 eyes) in which it was performed. CONCLUSIONS Choroidal ischemia may be the underlying mechanism of SDD-like lesions in patients with pre-eclampsia and MHT choroidopathy. These findings potentially are of utmost importance in understanding the mechanism of the reticular macular disease subtype of AMD. Reticular macular disease is characterized by the known association of choroidal insufficiency and SDD, with choroidal insufficiency postulated, but not proven, to be causative. Pre-eclampsia and MHT choroidopathy seems to be a model for lesions similar to SDD in AMD developing based on choroidal insufficiency and, as such, may offer further insights into the pathoetiologic features of SDD in AMD.
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Affiliation(s)
- Oscar Otero-Marquez
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hyewon Chung
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gerardo Ledesma-Gil
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sharmina Alauddin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Minsub Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Alauddin Bhuiyan
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - R Theodore Smith
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
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25
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Hébert M, You E, Gravel JF, Bourgault S. Serous retinal detachment following bronchoscopy-induced hypertensive emergency. Can J Ophthalmol 2020; 56:e51-e53. [PMID: 33080175 DOI: 10.1016/j.jcjo.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Serge Bourgault
- Université Laval, Québec, Que.; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Que..
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26
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Jayaraj S, Samanta R, Puthalath AS, Subramanian K. Pre-eclampsia associated bilateral serous retinal detachment. BMJ Case Rep 2020; 13:13/9/e238358. [PMID: 32933916 DOI: 10.1136/bcr-2020-238358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sreeram Jayaraj
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ramanuj Samanta
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Kavya Subramanian
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India
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27
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Mishima E, Funayama Y, Suzuki T, Mishima F, Nitta F, Toyohara T, Kikuchi K, Kunikata H, Hashimoto J, Miyazaki M, Harigae H, Nakazawa T, Ito S, Abe T. Concurrent analogous organ damage in the brain, eyes, and kidneys in malignant hypertension: reversible encephalopathy, serous retinal detachment, and proteinuria. Hypertens Res 2020; 44:88-97. [DOI: 10.1038/s41440-020-0521-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022]
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Hua D, Xu Y, Zhang X, He T, Chen C, Chen Z, Xing Y. Retinal Microvascular Changes in Hypertensive Patients with Different Levels of Blood Pressure Control and without Hypertensive Retinopathy. Curr Eye Res 2020; 46:107-114. [PMID: 32498561 DOI: 10.1080/02713683.2020.1775260] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine possible correlations between different levels of blood pressure (BP) control and retinal microvascular changes in the macula and optic nerve head, using coherence tomography angiography (OCTA) in hypertensive patients without hypertensive retinopathy. METHODS This was an observational, cross-sectional study. Seventy-three patients and 40 healthy volunteers were included in this study. The patients and volunteers were divided into four groups and from each participant one eye was selected randomly: Group A comprised 32 hypertensive patients with intensive BP control; Group B comprised 26 hypertensive patients with standard BP control; Group C comprised 15 hypertensive patients with poor BP control; Group D comprised 40 control subjects. 6 × 6 mm macula scan and 4.5 × 4.5 mm optic nerve head scan were obtained using OCTA. RESULTS In macula scans, most measured regions of retinal VD showed significant reduction in group C, compared to groups A, B, and D (all P < .05). Partial measured regions of retinal VD were significantly lower in group B than groups A and D (all P < .05). In ONH scans, RNFL thickness and inside disc capillary density were significantly thinner and lower in groups B and C than in group D (all P < .05). SBP was significantly correlated with RNFL thickness (R = 0.430, 95% CI -0.583 to -0.201, P ≤ 0.001). CONCLUSIONS We demonstrated that the frequency of OCTA follow-up may improve detection of reduced retinal VD, thus avoiding further retinal damage in hypertensive patients; however, the clinical implications of this finding deserve further study. Moreover, further exploration is needed regarding the implication that reduced SBP may be beneficial for lowering the risk of glaucoma.
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Affiliation(s)
- Dihao Hua
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Yishuang Xu
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Xiao Zhang
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Tao He
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Zhen Chen
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Yiqiao Xing
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
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29
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Tok A, Beyoğlu A. Antenatal and postpartum comparison of HD-OCT findings of macula, retinal nerve fiber layer, ganglion cell density between severe preeclampsia patients and healthy pregnant woman. Hypertens Pregnancy 2020; 39:252-259. [PMID: 32343154 DOI: 10.1080/10641955.2020.1758938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To investigate the effects of severe preeclampsia on the retinal nerve fiber layer (RNFL), macula thickness and ganglion cell density in pregnancy and postpartum, using High Definition Optical Coherence Tomography (HD-OCT). MATERIAL AND METHOD The study group included 28 stable pregnant patients diagnosed with severe preeclampsia and the control group, 28 age and gestational week-matched healthy pregnant women. HD-OCT measurements were taken by the same researcher using a Cirrus HD-OCT device and were repeated at 8 weeks postpartum. RESULTS The mean systolic pressure, diastolic pressure, and intraocular perfusion pressure (IPP) values measured in pregnacy were determined to be higher in the preeclampsia group than in the control group (158.4 ± 7.3 vs.113.6 ± 6.8, 97.0 ± 5.7vs.73.8 ± 5.9 and 68.1 ± 3.9 vs.48.8 ± 3.3 mm Hg, respectively) (p < 0.05 for all). The mean RNFL, macula thickness, ganglion cell analysis, and intraocular pressure (IOP) values during pregnancy were determined to be similar in both groups (p > 0.05 for all). No significant difference was determined postpartum between the groups in respect of mean systolic pressure, diastolic pressure, RNFL, macula thickness, ganglion cell analysis, and IOP values (114.3 ± 5.0 vs 114.6 ± 5.9 mm Hg, 74.6 ± 5.1 vs.74.5 ± 5.5 mm Hg, 96.0 ± 7.3 vs. 95.9 ± 6.7 µm, 228.2 ± 18.9 vs.234.5 ± 15.4 µm, 81.8 ± 8.0 vs. 84.2 ± 4.6 µm, 14.1 ± 2.4 vs.13.8 ± 2, respectively) (p < 0.05 for all). Mean IPP during pregnancy was higher than the mean postpartum IPP in the severe pre-eclampsia group (68.1 ± 3.9 vs 49.1 ± 3.1 mm Hg) (p < 0.001). CONCLUSION This is the first study to have evaluated ganglion cell density of the retina, macula thickness, and RNFL using HD-OCT in severe pre-eclampsia cases, both during pregnancy and postpartum.
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Affiliation(s)
- Abdullah Tok
- Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü Imam UniversityHospital , Kahramanmaras, Turkey
| | - Abdullah Beyoğlu
- Department of Ophtalmology, Kahramanmaraş Sütçü Imam UniversityHospital , Kahramanmaras, Turkey
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30
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Sheludchenko VM, Kozlovskaya NL, Smirnova TV, Krasnolutskaya EI. [Ophthalmic aspects of vascular and functional changes in malignant arterial hypertension of renal origin]. Vestn Oftalmol 2020; 136:324-332. [PMID: 32880158 DOI: 10.17116/oftalma2020136042324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Malignant arterial hypertension is a clinical syndrome characterized by severe diastolic arterial hypertension with signs of ischemic damage to target organs - kidneys, heart, brain, eyes. Malignant arterial hypertension can be one of the reasons, as well as a consequence of thrombotic microangiopathy - a special type of vascular lesions of the organ microvasculature. Ocular manifestations of arterial hypertension include hypertensive retinopathy of varying severity, choriopathy. The appearance of new diagnostic research methods allows a detailed study of eye damage in malignant arterial hypertension, whether associated or not with thrombotic microangiopathy, and to analyze the relationship of ocular and systemic manifestations of this disease to determine the nature and degree of involvement of the organ of vision in the pathological process and identify prognostic signs of disease progression and its forms.
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Affiliation(s)
| | | | - T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
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31
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Tsukikawa M, Stacey AW. A Review of Hypertensive Retinopathy and Chorioretinopathy. CLINICAL OPTOMETRY 2020; 12:67-73. [PMID: 32440245 PMCID: PMC7211319 DOI: 10.2147/opto.s183492] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/27/2020] [Indexed: 05/13/2023]
Abstract
Hypertensive retinopathy and choroidopathy have important short- and long-term implications on patients' overall health and mortality. Eye care professionals should be familiar with the severity staging of these entities and be able to readily recognize and refer patients who are in need of systemic blood pressure control. This paper will review the diagnosis, staging, treatment, and long-term implications for vision and mortality of patients with hypertensive retinopathy and choroidopathy.
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Affiliation(s)
- Mai Tsukikawa
- Department of Ophthalmology, University of Washington, Seattle, WA98104, USA
- Correspondence: Mai Tsukikawa Department of Ophthalmology, University of Washington, 325 Ninth Ave, Box 356421, Seattle, WA98104, USATel +1 206-221-7921Fax +1 206-685-7055 Email
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, WA98104, USA
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32
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Comment on: "Serous retinal detachment in preeclampsia and malignant hypertension". Eye (Lond) 2019; 33:1818. [PMID: 31278383 DOI: 10.1038/s41433-019-0514-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 11/09/2022] Open
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