|Year : 2021 | Volume
| Issue : 1 | Page : 133-134
Role of autofluorescence in Siegrist streaks
Anamika Patel, Bhavik Panchal, Avinash Pathengay
Department of Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
|Date of Submission||23-Mar-2020|
|Date of Acceptance||16-Jul-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Bhavik Panchal
Vitreoretina and Uveitis Services, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam - 530 040, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
A 41-year-old female presented to us with blurred vision in both eyes for the past 3 months. She was a known hypertensive and was treated for malignant hypertension in the past. She was diagnosed as hypertensive retinopathy with choroidopathy. Multiple hypopigmented linear streaks (Siegrist streaks) within the arcade and in the form of islands outside the arcades were noted. Fundus autofluorescence was performed to understand and classify the appearance and resolution of these streaks. Herein, we report the role of autofluorescence in describing Siegrist streaks secondary to hypertensive choroidopathy.
Keywords: Fundus autofluorescence, hypertensive choroidopathy, hypertensive retinopathy, malignant hypertension, Siegrist streaks
|How to cite this article:|
Patel A, Panchal B, Pathengay A. Role of autofluorescence in Siegrist streaks. Indian J Ophthalmol Case Rep 2021;1:133-4
Hypertension affects both the retinal and choroidal circulation although, hypertensive retinopathy is seen more commonly in the clinics. Hypertensive choroidopathy generally affects younger individuals and manifests in the form of Elschnig's spots, Siegrist streaks and retinal pigment epithelium detachment. Herein, we describe the autofluorescence features of Siegrist streaks seen in hypertensive choroidopathy.
| Case Report|| |
A 41-year-old female was referred by her rheumatologist to our clinic for complaints of blurred vision in both eyes for the past 3 months. She was a known hypertensive and a suspected case of medium and large vessel vasculitis. Her medical history showed that she was treated for malignant hypertension in the past and her blood pressure was under control at the time of presentation. Her best-corrected visual acuity (BCVA) was 20/20, N6 in both eyes (BE). Low contrast visual acuity (LCVA) was 20/20 in the right eye (RE) and 20/30 in the left eye (LE). She could read only demo plates while testing colour vision using Ishihara charts. BE anterior segment examination was unremarkable. Fundus evaluation of BE showed presence of disc edema, dilated, tortuous veins and severely attenuated arterioles. Multiple hypopigmented linear streaks within the arcade and in the form of islands outside the arcades were noted [Figure 1]a and [Figure 1]b. Fundus autofluorescence (AF) imaging showed the presence of granular AF in the form of linear streaks within the arcade [Figure 1]c and [Figure 1]d and outside the arcade in the form of large islands [Figure 1]e and [Figure 1]f. These lesions were identified as Siegrist streaks and a diagnosis of BE hypertensive retinopathy with choroidopathy was made.
|Figure 1: (a and b) Fundus photographs showing disc edema, dilated tortuous vessels and retinal pigment epithelium atrophy lesions. (c and d) Fundus autofluorescence showing granular autofluorescence in the form of linear streaks within the arcade. (e and f) Granular autofluorescence outside the arcade in the form of large islands|
Click here to view
The patient was advised fundus fluorescein angiography (FA) for further evaluation. At this time, she gave a history of undergoing treatment for a renal pathology as well. She was referred to the treating nephrologist for clearance for the FA. However, she was lost to follow-up. Two years later, she came back for routine ophthalmic evaluation, her BCVA in BE was 20/20 N6. Fundus evaluation showed resolved disc edema with peripapillary chorioretinal atrophy and the presence of attenuated vessels. Siegrist streaks had attained more complete depigmentation with few areas of hyperpigmentation and well-defined edges, seen to be present all along the arcades [Figure 2]a and [Figure 2]b. Fundus autofluorescence showed the presence of hypo autofluorescence denoting the retinal pigment epithelium atrophy at the areas of Siegrist streaks [Figure 2]c, [Figure 2]d, [Figure 2]e, [Figure 2]f. The patient is currently under treatment for systemic hypertension and had been advised to continue the systemic medications.
|Figure 2: (a and b) Fundus photographs showing resolved disc edema with mainly hypopigmented sub vascular lesions with few areas of hyperpigmentation. (c-f) Fundus autofluorescence showing resolution of linear streaks and islands - hypo auto fluorescent lesions|
Click here to view
| Discussion|| |
Ocular manifestations of hypertension affects both the retinal and choroidal circulation. Hypertensive choroidopathy is rare and less recognized compared to hypertensive retinopathy. Duke Elder has classified lesions due to hypertensive choroidopathy into pale yellow or reddish plaques in the peripheral fundus surrounded by pigmentary deposits, large patches of chorioretinal atrophy, Elschnig's spots and Siegrist's streaks. Siegrist's streaks are linear configurations of hyperpigmentation that develop over choroidal arteries in chronic hypertension.,, These are due to a patchy distribution of the sclerotic process in the choriocapillaris, consisting of hyperpigmentation over sclerotic choroidal vessels. The possible pathology described is the acute multifocal areas of fibrin platelet occlusion and necrosis of choriocapillaris which results in RPE necrosis.
Traditionally, fluorescein angiography has been used to confirm ophthalmoscopic suspicion of hypertensive choroidopathy, however, with the advent of autofluorescence, a non-invasive imaging modality, the diagnosis as well as the resolution can be well documented as in our case. Previously, Ramezani et al. have described the presence of doughnut-shaped hyper-autofluorescence in central macula as feature of chronic essential hypertension lasting more than 5 years.
Fundus autofluorescence clearly demonstrates the granular autofluorescence in the active stage of hypertensive choroidopathy and hypo autofluorescence in the late stage denoting RPE atrophy.
| Conclusion|| |
Siegrist streaks, a hallmark of hypertensive choroidopathy, can be easily diagnosed, classified and characterised by autofluorescence, a non-invasive imaging modality.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Hyderabad Eye Research Foundation.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ryan SJ. Hypertension. In: Retina. Vol. 2. St Louis: CV Mosby; 2018. p. 1125.
Siegrist A. Beitrag zur Kenntnis der Arteriosklerose der Augengefasse. In: IXth International Congress on (a) Ophthalmology 1899:131-9.
Phol ML. Siegrist's streaks in hypertensive choroidopathy. J Am Optom Assoc 1987;59:372-6.
Scholtz RO. Epivascular choroidal pigment streaks: Their pathology and possible prognostic significance. Bull Johns Hopkins Hosp 1945;77:345-71.
Bourke K, Patel MR, Prisant LM, Marcus DM. Hypertensive choroidopathy. J Clin Hypertens (Greenwich) 2004;6:471-2.
Ramezani A, Saberian P, Soheilian M, Parsa SA, Kamali HK, Entezari M, et al
. Fundus autofluorescence in chronic essential hypertension. J Ophthalmic Vis Res 2014;9:334-8. [Full text]
[Figure 1], [Figure 2]