Clinical Progressive Analysis of Serous Retinal detachment due to Hypertensive Choroidopathy in Toxemia of pregnancy

Hypertensive choroidopathy is seen in patients suffering from acute ypertension such as pregnancy-induced hypertension, renal disease, connective tissue disease, and accelerated essential hypertension, which can affect the visual acuity in many ways. Especially, retinal detachment is the most important factor in visual prognosis, so understanding its clinical course is important to the ophthalmologist. We diagnosed the 257 severe preeclampsia and eclampsia patinents at the Soonchunhyang University Hospital from January 1987 to Auguest 1996, and found 19 cases of serous retinal detachment. The fluorescein angiography showed delayed perfusion of the choriocapillaris in the earlyphase and marked pooling of dye in subretinal space in the late phase. The results of this study revealed that serous retinal detachment occured mostly binoculary (83.3%); the extent of the pathologic region ranged from 2.11DD to 7.2DD (mean 4.06DD); total bullous retinal detachment was found in one case; the duration of reattachment ranged from 8 to 43 days (mean 9.95days); and the recovery interval of visual acuity was between 21 to 35 days(average interval 18.5 days). Of 12 cases followed up 11 cases showed normal visual acuity, normal visual field and retinal reattachment without the macular degeneration.

Ischemic Changes in Hypertensive Choroidopathy by Fluorescein Angiography

The retinal and choroidal blood vessels respond independently to the abruptly increased arterial pressure due to their differences in the anatomic and physiologic properties, which induce hypertensive retinopathy and hypertensive choroidopathy respectively. The authors reviewed the fluorescein angiogram retrospectively to observe the ischemic changes of the choroid in 15 cases of hypertensive choroidopathy. The ischemic changes of the choroid in hypertensive choroidopathy were characterized by generalized or sectorial filling delay which was followed by staining or leakage of dye. These findings suggest that the choroidal circulation may lead to the sectorial and generalized ischemic conditions following the abruptly increased arterial pressure due to their differences in the anatomic structures. The fluorescein angiographic findings in the hypertensive choroidopathy depend on both the degree of the circulatory disturbance and the levels of the affected choroidal vessels.

Takayasu's Arteritis Associated with Serous Retinal Detachment

The authors experienced 2 cases of Takayasu's arteritis which were associated with serous retinal detachment in two young women. Retinal detachment in Takayasu's arteritis is a rare complication. In case 1, proximal hypertension was complicated due to atypical coarctation of thoracic aorta. So the choroidal vascular insufficiency and choroidal ischemia resulted in focal serous retinal detachment. In case 2, insufficient blood supply to the head and upper extremities resulted from coarctation of ascending aorta and its main branches, and the hypotensive collapse of choroidal vessels resulted in choroidal ischemia and focal serous retinal detachment. From these phenomena, we suggest that serous retinal detachment in Takayasu's arteritis can occur due to hypertensive choroidopathy or hypotensive choroidopathy.