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49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago. VISUAL ACUITY: OD 20/60, OS 20/25. IOP: OD 16, OS 13. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. There is a mild hyperpigmented area inferior to the macula. OS: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. The macula looks normal. OCT SCAN: The OCT scan from your office shows pigment epithelium thickening in the center of the right eye with subretinal fluid inferior to the fovea and some loss of photoreceptors. The left eye has a near normal scan. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows an area of irregular hyperfluorescence just inferior to the macula in the right eye, which stains in late frames but does not leak, nor does the nerve stain. There are patchy spots, which may be drusen or may be manifestations of his hypertensive retinopathy. The retinal vessels are irregular, both the arterials and the veins. The left eye similarly has patchy hyperfluorescence. There is a staining area inferior to the fovea and the retinal vessels are irregular and narrow. IMPRESSION: 1. CHRONIC HYPERTENSIVE RETINOPATHY – BOTH EYES 2. CHRONIC SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that chronic high blood pressure can cause subretinal fluid to build up and can cause vision loss. He is working on getting his blood pressure under control, probably through surgical treatment of the pheochromocytoma within the year and I am hopeful once his blood pressure normalizes the right macula will dry and at least there will be no further damage and possibly his vision will improve. I asked him to return here for a check in three months or sooner if he should notice a problem and to see you back regularly.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male329 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male188 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male380 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male185 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male124 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male178 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male81 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male80 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male112 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male192 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male94 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male120 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male80 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male85 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male58 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male69 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male56 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male74 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male108 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male125 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male118 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male172 views49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.

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49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago. VISUAL ACUITY: OD 20/60, OS 20/25. IOP: OD 16, OS 13. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. There is a mild hyperpigmented area inferior to the macula. OS: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. The macula looks normal. OCT SCAN: The OCT scan from your office shows pigment epithelium thickening in the center of the right eye with subretinal fluid inferior to the fovea and some loss of photoreceptors. The left eye has a near normal scan. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows an area of irregular hyperfluorescence just inferior to the macula in the right eye, which stains in late frames but does not leak, nor does the nerve stain. There are patchy spots, which may be drusen or may be manifestations of his hypertensive retinopathy. The retinal vessels are irregular, both the arterials and the veins. The left eye similarly has patchy hyperfluorescence. There is a staining area inferior to the fovea and the retinal vessels are irregular and narrow. IMPRESSION: 1. CHRONIC HYPERTENSIVE RETINOPATHY – BOTH EYES 2. CHRONIC SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that chronic high blood pressure can cause subretinal fluid to build up and can cause vision loss. He is working on getting his blood pressure under control, probably through surgical treatment of the pheochromocytoma within the year and I am hopeful once his blood pressure normalizes the right macula will dry and at least there will be no further damage and possibly his vision will improve. I asked him to return here for a check in three months or sooner if he should notice a problem and to see you back regularly.