Choroidal hyperpermeability was first described as a characteristic indocyanine green angiography (ICGA) finding seen in eyes with central serous chorioretinopathy and has been regarded as closely related to the pathophysiology of this entity. In the present study, the role of choroidal ischemia in producing ICGA choroidal hyperpermeability has been investigated in patients with hypertensive choroidopathy related to preeclampsia and malignant hyp ertension.


The clinical manifestations of hypertensive choroidopathy (33 patients with preeclampsia and 23 patients with malignant hypertension) are illustrated with various imaging modalities inclusive of: fundus photography, fundus autofluorescence, fluorescein angiography, ICGA, spectral-domain optical coherence tomography (OCT), enhanced depth imaging OCT, and OCT angiography.


Patients could become symptomatic from secondary involvement of the retinal pigment epithelium and subsequent damage to the outer blood-retinal barrier and outer retina. Diffuse areas of choroidal thickening with dilated choroidal vessels on OCT and choroidal hyperpermeability on ICGA are present in eyes with preeclampsia and malignant hypertension. A notable reduction in choroidal thickness as well as near complete resolution of serous detachment occurred after the initiation of therapy. Both choroidal thickness and vessels caliber decreased following treatment. Choroidal ischemia and arterial filling delays presumably occur in these patients due to acute and uncontrolled systemic hypertension.


These findings support the notion that local choroidal thickening in the areas of choroidal hyperpermeability could be induced by choroidal ischemia. In addition, following the acute event, the inner choroid appeared thinner corresponding to a decrease in total choroidal thickness, suggestive of choriocapillaris damage in these patients.


Hyewon Chung1*, Christopher Seungkyu Lee2, Eunyoung Choi2, Hyung Chan Kim2, Minsub Lee1
1Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
2The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
South Korea
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