Subretinal Drusenoid Deposit-Like Lesions Linked to Choroidal Ischemia

Ophthalmology office.
Ophthalmology office. Masked patient and doctor – Covid 19. Scan of the retina, an examination that allows you to precisely visualize the different parts of the eye. This imaging makes it possible to observe the retina in order to detect, for example, a retinal uplift with edema or a diabetic retinopathy. It is used to monitor wet AMD about every two months and complements the fundus to see if an injection of treatment is needed. OCT is also used to examine the optic nerve, and therefore screen for or monitor glaucoma. (Photo by: Pascal Bachelet/BSIP/Universal Images Group via Getty Images)
The finding was seen in patients with pre-eclampsia and malignant hypertension.

Optical coherence tomography (OCT) findings of subretinal drusenoid-like deposits may be caused by choroidal ischemia in patients who have hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension, according to research results published in Ophthalmology Retina. 

In a retrospective, cross-sectional study, researchers sought to describe the incidence of lesions similar in both structure and stage, to subretinal drusenoid deposits found in age-related macular degeneration (AMD), in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension. 

Patients with visual disturbances and either severe pre-eclampsia or malignant hypertension who were referred to a single center in South Korea between 2009 and 2019 were eligible for study inclusion. Those with severe pre-eclampsia had a blood pressure of 160/110 mm Hg or proteinuria of more than 5 g/24 hours, in addition to systemic symptoms such as headache, cerebral disturbances, pulmonary edema, and epigastralgia. Those with malignant hypertension had a high blood pressure — systolic ≥140 mm Hg or diastolic ≥90 mm Hg) as well as features of hypertensive retinopathy like retinal hemorrhage, exudates, cotton-wool spots, diffuse retinal edema, and optic disc edema. 

The study cohort included a total of 116 eyes from 58 patients: serous subretinal detachments were noted in 58 of 66 eyes of 33 patients (87.87%) with severe pre-eclampsia and in 47 of 50 eyes of 25 patients (94%) with malignant hypertension. Mean ages were 32.45±3.62 and 37.08±10.74 in each group, respectively. 

In the pre-eclampsia group, 27.3% of patients underwent their first evaluation during pregnancy and 72.7% underwent their first evaluation after delivery. All patients in this group were women. In the malignant hypertension group, 56% of patients were women; blood pressure profiles were significantly higher in those with malignant hypertension, and no difference in best-corrected visual acuity (BCVA) was noted during the acute phase between groups. 

Investigators identified subretinal drusenoid deposit-like lesions “exclusively” in eyes with serous subretinal detachments; in total, these lesions were observed in 28.57% of eyes with serous subretinal detachments, 32.76% of whom were from the pre-eclampsia group and 23.40% of whom were from the malignant hypertension group. In cases where these lesions were present, Grade 1 and Grade 2 lesions were most common in combination. 

During the recovery phase, BCVA increased in both groups, although this increase was more prominent in the pre-eclampsia group with an increase from 0.26±0.38 logMAR to 0.09±0.14 logMAR. In the malignant hypertension group, BCVA improved from 0.27±0.42 logMAR to 0.20±0.46. 

Features of hypersensitive retinopathy—including retinal hemorrhage, exudates, cotton-wool spots, diffuse retinal edema, and optic disc edema—were noted in 12.12% of pre-eclampsia eyes and 92% of malignant hypertension eyes. 

Subfoveal choroidal thickness decreased during the recovery phase, with a more prominent decrease in the pre-eclampsia group: a 28.4% decrease was noted, from 358±150.8 µm to 256.1±136.6 µm. In the malignant hypertension group, this decrease was 11.6%, from 321±101.1 µm to 283.7±111.7 µm. 

In 32.75% of all patients, SDD-like lesions were noted in at least 1 eye. No significant difference in blood pressure profiles or age was found when patients with and without these lesions were compared. However, eyes with SDD-like lesions had significantly worse BCVA during the acute phase. 

Among eyes with SDD-like lesions, 100% of eyes had serous retinal detachments (n=30), while these detachments occurred in 87.21% of eyes without SDD-like lesions (n=86).

Results of vascular imaging, performed in 6 patients (4 postpartum in the pre-eclampsia group) identified a number of common findings, including early choroidal filling delay and leakage and zones of hypofluorescence secondary to focal choroidal nonperfusion. 

Study limitations include the relatively small sample size and a lack of adjustment of choroidal thickness for age or axial length.

“This study demonstrated…a subacute model for the development of SDD-like lesions after severe hypertensive choroidopathy with SRD in young, healthy patients with pre-eclampsia and [malignant hypertension],” the researchers report. “A prospective study is…warranted of patients with pre-eclampsia and SRDs, with careful OCT angiography quantification of choriocapillaris perfusion, using validated algorithms to evaluate this hypothesized mechanism in the setting of hypertensive disorders of pregnancy.” 


Otero-Marquez O, Chung H, Lee CS, et al. Subretinal deposits in pre-eclampsia and malignant hypertension: Implications for age-related macular degeneration. Ophthalmol Retina. 2021;5(8):750-760. doi:10.1016/j.oret.2020.10.018