A prospective observational study to analyse the relationship between fundus changes in pregnancy induced hypertension with visual impairment and its reversibility

Background: Irreversible visual impairment and morbidity are associated with pregnancy induced hypertension. It causes pathological changes in vascularity of placenta, kidney and brain along with two major pathological types of changes in fundus namely arteriolar vasospasm and permeability changes in vascular endothelium. The aim of our study was to analyse the relationship between fundus changes in pregnancy induced hypertension with visual impairment and its reversibility.Methods: A prospective observational study done on pregnant women with any grade of pregnancy induced hypertension with recent visual impairment from 24 completed weeks of pregnancy.Results: Out of 75 patients with PIH, all the patients had varying degree of fundus changes in one or both eyes. In 150 eyes of the 75 patients, 86 (57.30%) eyes had isolated arteriolar vasospasm, 14 (9.33%) had grade III hypertensive retinopathy, 4 (2.66%) had grade IV hypertensive retinopathy, 30 (20%) had macular oedema, 4 (2.66%) had central serous chorioretinopathy, 2 (1.33%) had vascular occlusion, 2 (2.66%) eyes had normal fundus with cortical blindness, 2 (2.66%) had exudative retinal detachment, 6 (4%) eyes had normal fundus with changes in the other eye.Conclusions: Out of 75 patients, 7 (9.3%) patients had irreversible loss of vision, 3 (42.85%) due to arteriolar vasospasm, and 4 (57.15%) due to choroidal ischemia. Among the 4 patients with choroidal ischemia, 3 (75%) were in the group of eclampsia and 1 (25%) in gestational hypertension.

Ischemic Choroidal Diseases

Introduction Ischemic choroidal diseases are an underdiagnosed entity. The clinical pattern varies according to the size and the localisation of the affected vascular structure. Clinical Presentation In eyes with occlusion of the long posterior ciliary arteries, characteristic triangular patches of choroidal ischemia (Amalric sign) are seen, which in the course of time merge into well-defined areas of atrophy of the retinal pigment epithelium. Above the non-perfused choroidal areas, hyperpigmented, grouped lines appear (Siegrist streaks). Circumscribed ischemia of smaller choroidal arterioles and capillary vessels appears as multifocal, yellowish lesions in the posterior fundus (Elschnig spots). Vortex vein occlusion becomes manifest as exudative haemorrhagic choroidal swelling in the periphery. Causes of Choroidal Ischemia Apart from arterial hypertension as a major risk factor, some immunological disorders such as giant cell arteritis and systemic lupus erythematosus and haematological pathologies also affect choroidal perfusion. Furthermore, choroidal ischemia occurs due to local inflammation, as found in eyes with acute multifocal posterior placoid pigment epitheliopathy (APMPPE). Rarely, choroidal infarction is of iatrogenic origin or drug-induced. Recent advances in imaging, such as the introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A), have improved the visualisation of the choroidal vasculature and complement the classical angiographic procedures. In patients with age-related macular degeneration (AMD) and diabetes, some changes in choroidal blood flow and vascular structure have also been noted. While in AMD the choroidal pathologies correlate with the disease progression and the functional prognosis, the pathophysiological relationship between diabetic choroidopathy and retinopathy is currently unclear. Management and Conclusion With regard to the limited therapeutic options for choroidal ischemia, optimisation of the cardiovascular risk profile and the management of accompanying ocular and systemic diseases are essential.

Serous Retinal Detachment in Pre-eclampsia: Case Report and Literature Review

Pre-eclampsia (PE) is an obstetric disease with a multifactorial cause that affects ∼ 5% of pregnant women. Vision can be affected with varying severity, and retinal detachment is a very rare complication. It tends to be bilateral, diagnosed postpartum, and more prevalent in women who are primiparous and/or undergo caesarean delivery. The condition typically resolves completely and rarely causes total visual loss in the affected women. Fluorescence angiographic findings support the hypothesis that retinal detachment in PE is secondary to choroidal ischemia from intense arteriolar vasospasm. The present article is related to a case of a 37-year-old pregnant woman who had PE associated with a progressive blurred vision, diagnosed by ophthalmology as serous macular detachment of the retina.

Impaired Choroidal Blood Flow in Adolescents with Essential Arterial Hypertension

Arterial hypertension is a problem not only for adults, but also for children, but there are very few data on changes in the organ of vision under the influence of an elevated level of blood pressure in children.The aim of the work is to identify disturbances of the choroidal blood flow in children and adolescents with essential arterial hypertension.Methods. Fifty patients with essential arterial hypertension were examined. The age of patients ranged from 10 to 17 years, the duration of the disease ranged from 2 months to 8 years. All patients underwent color Doppler mapping of the orbital vessels, registration of the oscillatory potentials of the ERG.Results. It was revealed that increased arterial pressure causes retinal and choroidal ischemia, which is accompanied primarily by impaired blood flow in the orbital vessels and is reflected in a decrease in the amplitude and deformation of the peaks of the ERG oscillatory potentials.Conclusion. Hypertension causes and supports retinal and choroidal ischemia, which is accompanied primarily by impaired blood flow in the orbital vessels, functional depression of photoreceptors, ganglion cells and neuroglia of the retina, aggravating the identified changes as the experience of essential hypertension increases. A marker of chorioretinal ischemia is amplitude depression, a change in the shape of the teeth of the oscillatory potentials of the ERG, which indicates a decrease in the functional activity of the retinal ganglion complex.That is, these changes can be considered as a predictor of hypertensive angioretinopathy in children and adolescents with essential arterial hypertension.

Recurrent retinal and choroidal ischemia in a case of ocular ischemic syndrome

A 62 year-old male patient presented with fluctuating vision in both eyes. On fundus fluorescein angiogram, there was an area of choroidal and retinal ischemia in the left eye. The carotid evaluation revealed complete stenosis of the right internal carotid artery and 90% stenosis of the left internal carotid artery for which he underwent left modified endarterectomy. The vision and angiographic features improved after the procedure. Eleven months after the procedure, he again presented with choroidal ischemia due to recurrent left internal carotid artery blockage which improved gradually after carotid stenting.