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Case Reports
. 2017 Sep;96(39):e8110.
doi: 10.1097/MD.0000000000008110.

Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography: Case report

Tryfon Rotsos  1 , Konstantinos Andreanos, Stelios Blounas, Dimitrios Brouzas, Dimitrios S Ladas, Ioannis D Ladas
Affiliations
Case Reports

Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography: Case report

Tryfon Rotsos et al. Medicine (Baltimore). 2017 Sep.

Abstract

Rationale: To investigate malignant hypertension ocular lesions with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCT-A).

Patient concerns: Visual loss due to malignant hypertension.

Diagnoses: Hypertensive chorioretinopathy.

Interventions: Patients were thoroughly examined on presentation and 30 days after their first visit, with swept-source optical coherence tomography and optical coherence tomography angiography.

Outcomes: Lesions were totally absorbed during the follow-up time. Additionally, they presented fibrin deposits, as multiple solid hyper-reflective structures overlying retinal pigment epithelium, on both-SS-OCT and OCT-A. The last were still detected even larger in size at the last visit of the patients.

Lessons: These novel imaging examinations allow the ophthalmologist to detect in detail the several clinical manifestations of malignant hypertension on the fundus, and draw useful conclusions about their peculiar pathogenesis.

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Conflict of interest statement

The authors disclose no conflicts of interest.

Figures

Figure 1
Figure 1
Case 1: (A) First examination. SS-OCT of the right eye showing SRF, PEDs, and multiple hypereflective solid structures overlying the RPE at the macula. (B–E) One month later. SS-OCT (A) of the right eye showing complete resolution of SRF and PEDs. The hypereflective solid structures are still present. (C, D) SW-FAF of both eyes. Multiple hyper-autofluorescent lesions at the macula and the posterior pole. (E) OCT-A of the right eye showing multiple hypereflective irregular shaped lesions at the choriocapillaris layer. PED = pigment epithelium detachment, RPE = retinal pigment epithelium, SRF = subretinal fluid, SS-OCT = swept-source optical coherence tomography, SW-FAF = Snellen visual acuity assessment, fundoscopy, autofluorescence.
Figure 2
Figure 2
(A, B) Case 2 at first examination. SS-OCT of the right eye showing macular SRF, multiple solid hypereflective structures overlying the RPE, and wrinkling of the inner retinal layers with splitting of the ganglion cell and nerve fiber layer. RPE = retinal pigment epithelium, SRF = subretinal fluid, SS-OCT = swept-source optical coherence tomography.
Figure 3
Figure 3
Case 2 one month after first examination. (A, B) SS-OCT of both eyes. Complete resolution of the macula SRF with restoration of the retinal architecture. A slight parapillary SRF still remains and the solid hypereflective structures overlying the RPE are even larger in size. (C) OCT-A of the right eye showing multiple hypereflective irregular-shaped lesions at the choriocapillaris layer. (D) SS-FAF of the right eye showing multiple hyper-autofluorescent lesions at the macula and the posterior pole. OCT-A = optical coherence angiography, RPE = retinal pigment epithelium, SRF = subretinal fluid, SS-OCT = swept-source optical coherence tomography.
Figure 4
Figure 4
Right eye of case 2 one month after first examination. (A) OCT-A image does not seem to reveal any ischemic areas in the choriocapillaris layer corresponding to the Elschnig spots. (B) SS-OCT at the same area showing the thickness of the optical section of OCT-A. OCT-A = optical coherence angiography, SS-OCT = swept-source optical coherence tomography.
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References

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