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ANGIOGRAPHIC FINDINGS IN SEROUS RETINAL
PIGMENT EPITHELIUM DETACHMENT

ESTEBAN J. 1, ESPEJO V. 2, HUGUET E. 3, VERGARA J. 4.

Clínica Veterinaria Oftalmológica Ocaña, Madrid, Spain 1; Visualvet, Portugalete, Spain 2; Oftalmovet, Valencia, Spain 3; Clínica Veterinaria San Bernardo, San Sebastián, Spain 4.

Purpose:

The aim of this work is to show the importance of fluorescein angiography for the diagnosis of amaurosis in patients where electroretinography does not provide conclusive evidence of the origin of visual deficit and specially in Serous Retinal Pigment Epithelium Detachment (SRPD).

Methods:

Fluorescein angiography was performed in a Chihuahua (male, 2 years old) and a Boston terrier (female, 5 years old), with Topcon fundus cameras (TRC-50, X -50 and TRC 50-IA) in scotopic room. General anaesthesia was performed, with neuromuscular blocking and topical mydriasis. Sodium fluorescein (Fluoresceína Oculos 10%) was injected into the cephalic vein (25 mg/Kg) and the cornea was irrigated along the angiogram.

Chihuahua

2:06.2

0:35.2

0:11.8

Boston Terrier

2:10.4

0:15.2

0:10.7

0:27.8

0:22.9

Angiograms of both patients with SRPD showed visual impairment, bilateral mydriasis and incomplete and delayed Pupilary Light Reflexes (PLRs). No abnormalities were found on either ofthalmoscopic examination or electrorretinography.

Results:

We describe the results obtained from two cases with amaurosis, associated to Serous Retinal Pigment Epithelium Detachment and studied with fluorescence angiography.The early stages of the angiogram showed no significan changes (latency, choroidal, arterial, arterio-venous).In the early venous phase small spots appear, becoming hyperfluorescent in the periphery. The most significant data were obtained in the late venous phase of the angiogram: multiple hyperfluorescent areas that tend to coalesce were observed in the nontapetal area. The choriocapillaris vascular damage allows fluid diffusion through Bruch ‘s membrane which causes the lifting of the pigment epithelium. In normal contitions the hypofluorescence is masked behind the pigment epithelium, but the cells detached by the effusion have an abnormal metabolism and are permeated by the dye. As the disease progresses, plaque epiteliopathy can develop, leading to severe visual impairment. In both cases the vision was recovered after administration of systemic corticosteroids. Serous Retinal Pigment Epithelium Detachment, or retinal hives, is considered to be an immune-mediated based retinal disease.It is also knows as “retinal urticaria”.

Fig. 1

RETINA:

Non pigmented retinal pigment epithelium

Pigmented retinal pigment epithelium

CHOROID:

Bruch’s membrane

Choriocapillaris

Tapetum

Stroma

Large vessels layer

Suprachoroid

0:24.2

0:40.4

1:45.7

2:20.6

Boston terrier : Result of the angiogram after the steroid therapy: Prednisone (1 mg/ kg) for one month. Note the disappearance of the hyperfluorescent areas.

Conclusions:

Fluorescein angiography is extremely important in the diagnosis of retinal vascular diseases that present visual deficit and the absence of ophthalmoscopic and electroretinographic signs, and is relevant in patients suspected of serous retinal pigment epithelium detachment.

Bibliographie:

1. Lescure F. Fluorescein Angiographic Atlas of the Small Animal Ocular Fundus. Conférence Nationale des Vétérinaires Spécialisés en Petits Animaux. Paris. 1998: 225-227.

2. Villagrasa M. Diagnostic des affections de l’epithelium pigmentaire rétinien chez le chien. Comptes rendus de Congrés de la Conférence Nationale des Vétérinaires Spécialisés en Petits Animaux, Paris. 1995: 205-208.

3. Ortiz M., Salas V., Martínez E., Villagrasa M. Amaurosis: Utilidad del estudio angiográfico. II Congreso SEOVET (Sociedad Española de Oftalmología Veterinaria) 19- 20 Abril 2013.