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68-year-old woman was seen in the office on 5/11/2011. She has had poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She had cataract surgery done on April 18th and April 23rd and her vision is still poor. She had intravitreal Avastin injections April 7th and May 5th, but her vision was no better after the injections. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous lately and sick. She has had vision where she could see to get around and see people about six months ago but she has not seen much since then. VISUAL ACUITY: Her vision is 1/200 in each eye. IOP: OD 18, OS 14. SLIT LAMP EXAM: She has trace corneal edema and the posterior chamber intraocular lens is in good position. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is dilation of the retinal veins. There is 3+ cystoid macular edema. There are microaneurysms around the fovea. There are also extensive macular exudates. There are 3+ cotton-wool spots surrounding the optic nerve. OS: Vertical C/D ratio is 0.2. There is 3+ cystoid macular edema. Again, there are multiple cotton-wool spots indicative of hypertensive retinopathy. There are microaneurysms, exudates, and hemorrhage. OCT SCAN: The OCT scan shows in the right eye an average central foveal thickness of 641 microns with a volume of 15.49 mm³ and the left eye 684 microns with a volume of 16.34 mm³. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows reasonably good circulation with good filling of the retinal arteries and normal recirculation time of less than 4 seconds. The retinal capillaries look reasonably good considering the extent of the vasculopathy. There is diffuse leakage in the late frames from all the retinal vessels. IMPRESSION: 1. MALIGNANT HYPERTENSION WITH HYPERTENSIVE RETINOPATHY AND MACULAR EDEMA 2. DIABETIC RETINOPATHY 3. RECENT CATARACT SURGERY DISCUSSION: I explained to the patient with the hypertensive retinopathy she needs to have her blood pressure lowered. With lowering the blood pressure, there is a reasonable chance over the next six months the macular edema will subside. I think it would be reasonable to consider other treatments, but I think initially she needs treatment for the hypertensive retinopathy and that may be all she needs to better control her retinal vascular disease. I think there is about at least a 50/50 chance her vision will substantially improve over six months with better blood pressure control. I am also concerned about her constitutional symptoms and that she may have a problem with cerebral swelling because of the nausea and vomiting. I will fax this to your office. She will probably be seeing you tomorrow. I appreciate you following up with this. I asked her to return here for check in six to eight weeks. I will repeat the OCT scan. If at that time the macula is less swollen, I will just follow her; but if not, I may consider bilateral intravitreal injections of Avastin.

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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic183 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic129 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic131 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic96 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic89 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic70 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic49 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic67 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic66 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic52 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic131 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic75 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic81 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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Malignany Hypertension - BP 250/130 - Vision 1/200 in each eye - Diabetic96 views68-year-old woman poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous 00000
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68-year-old woman was seen in the office on 5/11/2011. She has had poor vision in both eyes for the last few years. She is diabetic since 1989. Her blood pressure has been very high. She had cataract surgery done on April 18th and April 23rd and her vision is still poor. She had intravitreal Avastin injections April 7th and May 5th, but her vision was no better after the injections. She was in the hospital Friday. Her blood pressure during that visit was 250/130 and her blood pressure in your office she reports was somewhere around the same. I just checked her blood pressure at the beginning of my visit and it was 200/120 in her right arm sitting. Her vision is poor enough that she can barely see to walk around. She has also been feeling nauseous lately and sick. She has had vision where she could see to get around and see people about six months ago but she has not seen much since then. VISUAL ACUITY: Her vision is 1/200 in each eye. IOP: OD 18, OS 14. SLIT LAMP EXAM: She has trace corneal edema and the posterior chamber intraocular lens is in good position. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is dilation of the retinal veins. There is 3+ cystoid macular edema. There are microaneurysms around the fovea. There are also extensive macular exudates. There are 3+ cotton-wool spots surrounding the optic nerve. OS: Vertical C/D ratio is 0.2. There is 3+ cystoid macular edema. Again, there are multiple cotton-wool spots indicative of hypertensive retinopathy. There are microaneurysms, exudates, and hemorrhage. OCT SCAN: The OCT scan shows in the right eye an average central foveal thickness of 641 microns with a volume of 15.49 mm³ and the left eye 684 microns with a volume of 16.34 mm³. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows reasonably good circulation with good filling of the retinal arteries and normal recirculation time of less than 4 seconds. The retinal capillaries look reasonably good considering the extent of the vasculopathy. There is diffuse leakage in the late frames from all the retinal vessels. IMPRESSION: 1. MALIGNANT HYPERTENSION WITH HYPERTENSIVE RETINOPATHY AND MACULAR EDEMA 2. DIABETIC RETINOPATHY 3. RECENT CATARACT SURGERY DISCUSSION: I explained to the patient with the hypertensive retinopathy she needs to have her blood pressure lowered. With lowering the blood pressure, there is a reasonable chance over the next six months the macular edema will subside. I think it would be reasonable to consider other treatments, but I think initially she needs treatment for the hypertensive retinopathy and that may be all she needs to better control her retinal vascular disease. I think there is about at least a 50/50 chance her vision will substantially improve over six months with better blood pressure control. I am also concerned about her constitutional symptoms and that she may have a problem with cerebral swelling because of the nausea and vomiting. I will fax this to your office. She will probably be seeing you tomorrow. I appreciate you following up with this. I asked her to return here for check in six to eight weeks. I will repeat the OCT scan. If at that time the macula is less swollen, I will just follow her; but if not, I may consider bilateral intravitreal injections of Avastin.