[Serous retinal detachment in O2 therapy of primary pulmonary hypertension]

Primary pulmonary hypertension (PPH) is a rare disease, which almost inevitably leads to right-sided heart failure and death. This is to our knowledge the first report of ophthalmological complications. A 43-year-old woman in the late stage of PPH who had been continuously treated with oxygen developed an uveal effusion syndrome, which manifested as bilateral central serous retinal detachment and ciliochoroidal swelling. The serous detachment improved promptly after interruption of the oxygen therapy and again worsened when it was resumed because of massive dyspnea. Systemic blood pressure was 115/95. Right-sided cardiac catheterization revealed a systolic pulmonary arterial pressure of 110 mmHg. Pulmonary function tests showed a normal PO2 with oxygen and a light hypoxia without therapy. We came to the following conclusions: First, the central serous retinal detachment and peripheral choroidal swelling were induced by the striking increase in pulmonary arterial pressure, which almost equaled the systemic arterial pressure. Although the same ophthalmological findings have been reported in experimental animals after exposure to pure oxygen, pulmonary function tests disproved high oxygen concentration as the causative agent in our patient. Second, the improvement of pigment epithelial function after the interruption of oxygen therapy could be explained by the following hypotheses. Hypoxia induced a dilation of the choroidal arteries, followed by an improved supply of nutritive material for the pigment epithelium. There is experimental evidence that glucose might be the limiting metabolite of pigment epithelial function.