Hypertensive Retinopathy - Serous Macular (Retinal) Detachment
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59-year-old woman was seen in the office on 12/5/08. She has had decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She has been on Lasix and other blood pressure medicines for a few years, but she has not been taking them religiously. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30. IOP: OD 20, OS 18.
AMSLER GRID: The right eye is normal. The left eye has a central scotoma.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are 1+ arteriovenous crossing changes.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are 1+ arteriovenous crossing changes. There is a serous macular detachment.
OCT SCAN: The OCT scan of the right eye is normal. The left eye shows a serous macular detachment.
PHOTOGRAPHS: Color photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a hyperfluorescent area about 800 microns across, superior to the fovea, with a dot area which is leaking into the fovea in the late frames.
I checked her blood pressure and it was 180/100.
IMPRESSION: 1. HYPERTENSIVE RETINOPATHY
2. SEROUS MACULAR DETACHMENT – LEFT EYE
DISCUSSION: I explained to the patient she does have hypertensive retinopathy which suggests she is at high risk of complications of high blood pressure. I asked her to take her medicines as directed, to continue her salt restrictions and exercise, and to see Dr. Kudelko next week for an urgent evaluation. If her blood pressure remains high at home, I told her she may want to go to the emergency room for an evaluation and urgent control of her high blood pressure.
Follow-up:
3/27/2009. This pleasant 59-year-old woman has a serous macular detachment in the left eye, probably associated with hypertensive retinopathy but there may be a central serous retinopathy component to it as well. Her vision is gradually getting a little better since she initially saw me in December of 2008.
VISUAL ACUITY: Vision OS is 20/40. IOP: OS 19. The lens is clear.
EXTENDED OPHTHALMOSCOPY:
OS: Vertical C/D ratio is 0.3. There is a tiny serous macular detachment. There is a little pigment spot just temporal to the fovea.
OCT SCAN: The OCT scan shows decreased central subretinal fluid. The pocket of subretinal fluid today is about 100 microns thick and last visit it was about twice as thick.
IMPRESSION:
1. DECREASING SEROUS MACULAR DETACHMENT – LEFT EYE
2. POSSIBLE COMPONENT OF CENTRAL SEROUS RETINOPATHY – LEFT EYE
3. HYPERTENSIVE RETINOPATHY – LEFT EYE
DISCUSSION: I explained to the patient the macula does look better today. I asked her to return for check when she returns next fall and she will see you back regularly.
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy494 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy571 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy565 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy583 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy601 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy489 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy472 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy514 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy459 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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Serous Macular Detachment Left Eye - Possible Hypertensive Choroidopathy v. Central Serous Retinopathy527 views59-year-old woman decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30
(0 votes)
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59-year-old woman was seen in the office on 12/5/08. She has had decreasing vision in the left eye for about two days. She sees a spot in front of her vision. It is a yellow spot which is just straight ahead and moves with her eye. She does have high blood pressure. She has been on Lasix and other blood pressure medicines for a few years, but she has not been taking them religiously. She checks her blood pressure at home, and even at home her blood pressure runs very high, with the systolic running around 200 and the diastolic around 100, although occasionally it does return to the normal range.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/30. IOP: OD 20, OS 18.
AMSLER GRID: The right eye is normal. The left eye has a central scotoma.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are 1+ arteriovenous crossing changes.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are 1+ arteriovenous crossing changes. There is a serous macular detachment.
OCT SCAN: The OCT scan of the right eye is normal. The left eye shows a serous macular detachment.
PHOTOGRAPHS: Color photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a hyperfluorescent area about 800 microns across, superior to the fovea, with a dot area which is leaking into the fovea in the late frames.
I checked her blood pressure and it was 180/100.
IMPRESSION: 1. HYPERTENSIVE RETINOPATHY
2. SEROUS MACULAR DETACHMENT – LEFT EYE
DISCUSSION: I explained to the patient she does have hypertensive retinopathy which suggests she is at high risk of complications of high blood pressure. I asked her to take her medicines as directed, to continue her salt restrictions and exercise, and to see Dr. Kudelko next week for an urgent evaluation. If her blood pressure remains high at home, I told her she may want to go to the emergency room for an evaluation and urgent control of her high blood pressure.
Follow-up:
3/27/2009. This pleasant 59-year-old woman has a serous macular detachment in the left eye, probably associated with hypertensive retinopathy but there may be a central serous retinopathy component to it as well. Her vision is gradually getting a little better since she initially saw me in December of 2008.
VISUAL ACUITY: Vision OS is 20/40. IOP: OS 19. The lens is clear.
EXTENDED OPHTHALMOSCOPY:
OS: Vertical C/D ratio is 0.3. There is a tiny serous macular detachment. There is a little pigment spot just temporal to the fovea.
OCT SCAN: The OCT scan shows decreased central subretinal fluid. The pocket of subretinal fluid today is about 100 microns thick and last visit it was about twice as thick.
IMPRESSION:
1. DECREASING SEROUS MACULAR DETACHMENT – LEFT EYE
2. POSSIBLE COMPONENT OF CENTRAL SEROUS RETINOPATHY – LEFT EYE
3. HYPERTENSIVE RETINOPATHY – LEFT EYE
DISCUSSION: I explained to the patient the macula does look better today. I asked her to return for check when she returns next fall and she will see you back regularly.
