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. 


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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.” 

Reference

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