hypertensive disease , in which there is persistent pathologic elevation of arterial pressure and increased total peripheral resistance , is associated with vascular lesions in the brain , heart , kidneys , and eyes .
elevation of systemic blood pressure causes both focal and generalized retinal arteriolar constriction , presumably mediated by autoregulation .  
a prolonged duration of particularly high blood pressure can be associated with a breakdown of the inner blood - retinal barrier , with extravasation of plasma and red blood cells .
retinal hemorrhages , cottonwool spots , intraretinal lipid , and , in severe cases , the development of a macular star configuration of intraretinal lipid can be seen [ 13 ] .
when the choroidal vessels are severely affected by elevated blood pressure , as in acute hypertension , fibrinoid necrosis of choroidal arterioles can cause occlusion of areas of choriocapillaris , with a subsequent breakdown of the outer blood - retinal barrier . in severe cases the optic nerve can be involved .
although the retinal vascular changes and optic neuropathy are well known , hypertensive choroidopathy usually does not receive as much attention .
hypertensive choroidopathy has been reported in toxemia of pregnancy , renal disease , pheochromocytoma , and malignant hypertension .
a 50-year - old man presented with a painless loss of vision in his both eyes and dull , pressure - like frontal headache .
the best - corrected visual acuity ( bcva ) was 20/200 and 20/50 in the right and left eyes , respectively .
he had a history of anterior ischemic optic neuropathy in the right eye 30 years ago .
slit - lamp examination showed serous retinal detachment in both eyes and optic disc swelling in the left eye ( figures 1 and 2 ) .
retinal arteriolar narrowing , vascular tortuosity , and arteriovenous nicking were identified in both eyes .
fundus fluorescein angiography ( fa ) showed window defect associated with the macular cystoid change .
indocyanine green angiography ( ia ) showed decreased perfusion of the choroid at the macula in both eyes .
he had a history of hypertension 1 year ago , but had no medical treatment .
on posttreatment day 30 , the serous retinal detachment disappeared in both eyes ( figures 3 and 4 ) .
his bcva was recovered to 20/500 and 20/16 in the right and left eyes , respectively .
the optic disc in the right eye remained pale due to anterior ischemic optic neuropathy 30 years ago .
severe systemic hypertension is associated with significant damage of end   organs , such as eyes , heart , central nervous system , and kidneys .
the ophthalmic artery branch of the internal carotid artery supplies the optic nerve and retina , extraocular muscles , and eyelids .
branches of ophthalmic artery include the central retinal artery and short and long posterior ciliary arteries . the central retinal artery and vein supply the inner ( anterior ) two thirds of the retina .
the choroidal circulation receives blood primarily from the short and long posterior ciliary arteries and delivers blood to the retinal pigment epithelium , optic nerve , and outer ( posterior ) one third of the retina .
the retinal photoreceptors and pigment epithelium are nourished by an inner layer of the choroid which is called the choriocapillaris . accelerated hypertension and/or
ophthalmic / ciliary artery occlusion may result in choroidal ischemia . with complete ophthalmic artery occlusion , both
compromise of ciliary arteries may occur without retinal artery involvement , leading to choroidal ischemia , which causes hypertensive choroidopathy .
the rpe becomes necrotic ; this may result in serous retinal detachment and/or localized pigment epithelial detachment .
some of these are attributed to a breakdown of the inner blood - retinal barrier with retinal endothelial cell decompensation .  
it is notable that no active leakage is observed in the area with serous retinal detachment in our patient .
ia shows hypofluorescence along the retinal artery . although it is unclear that this finding is cause or effect , it may play a role in the pathogenesis of this case .
the narrowed arterioles , vascular tortuosity , and arteriolovenous nicking in the retinal vessels were also observed .
it seems that the patient had a history of longstanding chronic hypertension , and a sudden bp elevation triggered it off and formed this condition .
after antihypertension treatment , the serous retinal detachment disappeared , and his bcva was recovered . in most cases with hypertensive choroidopathy , visual acuity returns to normal by controlling their bp .
however , there is a case reporting that the visual acuity was not recovered in spite of being controlled the bp .    
a patient with those findings should be considered as hypertensive choroidopathy and treated with antihypertension therapy as soon as possible .
 
 purpose . 
 we report a case of hypertensive choroidopathy with bilateral serous retinal detachments . 
 patient . 
 a 50-year - old man underwent bilateral serous retinal detachments . 
 retinal arteriolar narrowing , vascular tortuosity , and arteriovenous nicking were identified in both eyes . 
 the blood pressure was 206/125  mmhg . 
 the patient was diagnosed with bilateral hypertensive choroidopathy and treated with oral antihypertensive treatment . 
 
 results and discussion . 
 one month after antihypertensive treatment , the serous retinal detachments resolved and the visual acuity improved . 
 a patient with those findings should be considered as having hypertensive choroidopathy and treated as soon as possible . 
 
1. Introduction
2. Case Report
3. Discussion