Hypertensive Retinopathy - Choroidal Ischemia
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39-year-old man two days ago he noticed poor vision in his right eye. He does have diabetes for two years and a history of high blood pressure for about six months, for which he takes medicines.
VISUAL ACUITY: OD: 8/200; OS: 20/20. IOP: 21 in each eye.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: C/D ratio is 0.2. There is no posterior vitreous separation. There is a serous macular detachment. There are patchy retinal hemorrhages and cotton wool spots.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are patchy retinal hemorrhages and cotton wool spots. There are arterial venous crossing changes.
The OCT scan shows a serous macular detachment in the right eye. The left eye had a normal foveal contour.
A fluorescein angiogram shows a choroidal infarct in the right eye just inferior to the fovea. The left eye has a few hypo- and hyperfluorescent scars and corresponding hemorrhage and cotton wool spots. The infarct perfuses within about fifteen seconds. I checked his blood pressure and it was 240/120. Photos confirm clinical findings.
IMPRESSION:
1. MALIGNANT HYPERTENSION.
2. SEROUS MACULAR DETACHMENT IN THE RIGHT EYE.
3. POSSIBLE OVERLYING DIABETIC RETINOPATHY.
DISCUSSION: I explained to the patient that his blood pressure is high and it is causing him to lose his vision, and there is a risk of other systemic problems in his case. I asked him to go directly to the Emergency Room. I also asked him to return here for a check in six weeks. Once his blood pressure comes under control the eye probably will, but it may take a few months.
ONE YEAR LATER:
pleasant 40-year-old man had hypertensive retinopathy when I saw him in December. His vision has improved now that his blood pressure is under better control. He was diagnosed with IgA nephropathy and he is on medication for that now. He is also diabetic.
VISUAL ACUITY: OD 20/30, OS 20/25. IOP: OD 13, OS 14. The lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OCT SCAN: The OCT scan of the right eye is back to normal. The left eye shows minimal parafoveal thickening.
IMPRESSION:
1. RESOLVED HYPERTENSIVE RETINOPATHY
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39-year-old man two days ago he noticed poor vision in his right eye. He does have diabetes for two years and a history of high blood pressure for about six months, for which he takes medicines.
VISUAL ACUITY: OD: 8/200; OS: 20/20. IOP: 21 in each eye.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: C/D ratio is 0.2. There is no posterior vitreous separation. There is a serous macular detachment. There are patchy retinal hemorrhages and cotton wool spots.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are patchy retinal hemorrhages and cotton wool spots. There are arterial venous crossing changes.
The OCT scan shows a serous macular detachment in the right eye. The left eye had a normal foveal contour.
A fluorescein angiogram shows a choroidal infarct in the right eye just inferior to the fovea. The left eye has a few hypo- and hyperfluorescent scars and corresponding hemorrhage and cotton wool spots. The infarct perfuses within about fifteen seconds. I checked his blood pressure and it was 240/120. Photos confirm clinical findings.
IMPRESSION:
1. MALIGNANT HYPERTENSION.
2. SEROUS MACULAR DETACHMENT IN THE RIGHT EYE.
3. POSSIBLE OVERLYING DIABETIC RETINOPATHY.
DISCUSSION: I explained to the patient that his blood pressure is high and it is causing him to lose his vision, and there is a risk of other systemic problems in his case. I asked him to go directly to the Emergency Room. I also asked him to return here for a check in six weeks. Once his blood pressure comes under control the eye probably will, but it may take a few months.
ONE YEAR LATER:
pleasant 40-year-old man had hypertensive retinopathy when I saw him in December. His vision has improved now that his blood pressure is under better control. He was diagnosed with IgA nephropathy and he is on medication for that now. He is also diabetic.
VISUAL ACUITY: OD 20/30, OS 20/25. IOP: OD 13, OS 14. The lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OCT SCAN: The OCT scan of the right eye is back to normal. The left eye shows minimal parafoveal thickening.
IMPRESSION:
1. RESOLVED HYPERTENSIVE RETINOPATHY
