TY - JOUR
T1 - Subretinal Deposits in Pre-eclampsia and Malignant Hypertension
T2 - Implications for Age-Related Macular Degeneration
AU - Otero-Marquez, Oscar
AU - Chung, Hyewon
AU - Lee, Christopher Seungkyu
AU - Choi, Eun Young
AU - Ledesma-Gil, Gerardo
AU - Alauddin, Sharmina
AU - Lee, Minsub
AU - Bhuiyan, Alauddin
AU - Smith, R. Theodore
N1 - Funding Information:
Supported by the National Institutes of Health, Bethesda, Maryland (grant no.: R01 EY015520 [R.T.S.]). Obtained funding: Smith
Funding Information:
Supported by the National Institutes of Health , Bethesda, Maryland (grant no.: R01 EY015520 [R.T.S.]).
Publisher Copyright:
© 2020 American Academy of Ophthalmology
PY - 2021/8
Y1 - 2021/8
N2 - Purpose: To describe the incidence of subretinal deposits that are similar in structure and stage on OCT imaging to subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension (MHT) and the implications of this ischemic choroidopathy for the pathophysiologic characteristics of SDDs in AMD. Design: Retrospective cross-sectional study. Participants: Thirty-three pre-eclampsia patients and 25 MHT patients with serous retinal detachment (SRD) in at least 1 eye were included. Methods: Serial multimodal images, including enhanced depth imaging spectral-domain OCT of eyes with hypertensive choroidopathy secondary to pre-eclampsia and MHT, were reviewed at 2 time points, the acute phase (within 4 weeks of initial hypertensive insult) and the recovery phase (beyond 4 weeks). Main Outcome Measures: Incidence of SDD-like lesions in patients with hypertensive choroidopathy secondary to pre-eclampsia and MHT. Results: Subretinal drusenoid deposit-like lesions were observed exclusively in eyes with SRD. Serous retinal detachment occurred in 87.87% of eyes of pre-eclampsia patients and in 94% of eyes of MHT patients. Subretinal drusenoid deposit-like lesions occurred in 28.57% of all eyes with SRD, in 32.76% of eyes with SRD from the pre-eclampsia group, and in 23.40% of eyes with SRD from the MHT group. Vascular imaging suggested underlying choroidal ischemia in all patients (12 eyes) in which it was performed. Conclusions: Choroidal ischemia may be the underlying mechanism of SDD-like lesions in patients with pre-eclampsia and MHT choroidopathy. These findings potentially are of utmost importance in understanding the mechanism of the reticular macular disease subtype of AMD. Reticular macular disease is characterized by the known association of choroidal insufficiency and SDD, with choroidal insufficiency postulated, but not proven, to be causative. Pre-eclampsia and MHT choroidopathy seems to be a model for lesions similar to SDD in AMD developing based on choroidal insufficiency and, as such, may offer further insights into the pathoetiologic features of SDD in AMD.
AB - Purpose: To describe the incidence of subretinal deposits that are similar in structure and stage on OCT imaging to subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension (MHT) and the implications of this ischemic choroidopathy for the pathophysiologic characteristics of SDDs in AMD. Design: Retrospective cross-sectional study. Participants: Thirty-three pre-eclampsia patients and 25 MHT patients with serous retinal detachment (SRD) in at least 1 eye were included. Methods: Serial multimodal images, including enhanced depth imaging spectral-domain OCT of eyes with hypertensive choroidopathy secondary to pre-eclampsia and MHT, were reviewed at 2 time points, the acute phase (within 4 weeks of initial hypertensive insult) and the recovery phase (beyond 4 weeks). Main Outcome Measures: Incidence of SDD-like lesions in patients with hypertensive choroidopathy secondary to pre-eclampsia and MHT. Results: Subretinal drusenoid deposit-like lesions were observed exclusively in eyes with SRD. Serous retinal detachment occurred in 87.87% of eyes of pre-eclampsia patients and in 94% of eyes of MHT patients. Subretinal drusenoid deposit-like lesions occurred in 28.57% of all eyes with SRD, in 32.76% of eyes with SRD from the pre-eclampsia group, and in 23.40% of eyes with SRD from the MHT group. Vascular imaging suggested underlying choroidal ischemia in all patients (12 eyes) in which it was performed. Conclusions: Choroidal ischemia may be the underlying mechanism of SDD-like lesions in patients with pre-eclampsia and MHT choroidopathy. These findings potentially are of utmost importance in understanding the mechanism of the reticular macular disease subtype of AMD. Reticular macular disease is characterized by the known association of choroidal insufficiency and SDD, with choroidal insufficiency postulated, but not proven, to be causative. Pre-eclampsia and MHT choroidopathy seems to be a model for lesions similar to SDD in AMD developing based on choroidal insufficiency and, as such, may offer further insights into the pathoetiologic features of SDD in AMD.
KW - Age-related macular degeneration
KW - Malignant hypertension
KW - Pre-eclampsia
KW - Serous retinal detachment
KW - Subretinal drusenoid deposit
UR - http://www.scopus.com/inward/record.url?scp=85100677953&partnerID=8YFLogxK
U2 - 10.1016/j.oret.2020.10.018
DO - 10.1016/j.oret.2020.10.018
M3 - Article
C2 - 33130003
AN - SCOPUS:85100677953
SN - 2468-6530
VL - 5
SP - 750
EP - 760
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 8
ER -