Indocyanine green angiographic findings of hypertensive choroidopathy

To evaluate fundus lesions in patients with malignant hypertension with indocyanine green angiography (ICGA).

Cases of hypertensive choroidopathy were followed prospectively with ICGA, fluorescein angiography (FA), and optical coherence tomography (OCT).

In Case 1, a 34-year-old man had a 10-day history of blurred vision in both eyes. Visual acuity was 0.2 in the right eye and 0.01 in the left eye. Blood pressure (BP) was 270/178 mmHg, and laboratory tests disclosed severe renal dysfunction. In Case 2, a 31-year-old man had noticed blurred vision in both eyes. Visual acuity was 1.2 in the right eye and 1.0 in the left eye. BP was 272/180 mmHg. Marked optic edema, retinal hemorrhage, cotton-wool patches, and Elschnig spots were seen in both cases. FA showed poorly perfused choroid in the early phase and fluorescein dye leakage from the optic disk. OCT demonstrated serous retinal detachment in both cases. ICGA revealed Elschnig spots corresponding to the patchy choroidal filling defect. ICGA demonstrated a larger area of choroidal filling defect than FA. In Case 1, ICGA revealed dye leakage from large choroidal vessels. These OCT and ICGA findings reduced after early systemic treatment for malignant hypertension.

Hypofluorescent spots in the choroid thought to be choriocapillaris occlusion and choroidal vessel damage recover as result of early treatment for malignant hypertension. ICGA is useful to reveal the disturbance of choroidal circulation in hypertensive choroidopathy.