Atlas of Ophthalmology

Therapeutischer Effekt einer antihypertensiven Therapie bei beiseitiger maligner hypertensiver Retinopathie (Farbphotographie Hinterer Pol, OCT)

Hypertensive Retinopathie
Patient: 17 years of age, male, initial BCVA 0.2 at OD, 0.8 at OS. Two months later, after antihypertensive treatment BCVA improved to 0.8 at OD, and 1.0 at OS. Ocular Medical History: blurry vision at OD. General Medical History: no subjective symptoms, by chance detection of arterial hypertension with systolic blood pressure >200mmHg, chronic nephrotic insufficieny with serum creatinine concentration of 2,8 mg per deciliter, proteinuria with 294 mg/ml/day, hematuria 10/µl. Renal histology revealed a hypertensive-ischemic nephropathy with arterio-arteriololo-sclerosis of the kidney. Purpose: to show the effect of antihypertensive medication in hypertensive retinopathy. Methods: Colour photography posterior segment, Optical Coherence Tomography. Findings: Colour Photography Posterior Segment, initial finding in OD: bilateral optic disk edema with surrounding soft and hard exudates, flame-shaped hemorrhages, reduced retinal arterial caliber, cotton wool patches. OCT RNFL circle scans, initial finding in OD: edema of all retinal layers, intraretinal and subretinal fluid temporal and nasal to the disc. OCT, initial finding in OD: edema of all retinal layers, intraretinal and subretinal fluid. Colour Photography Posterior Segment, after two months of therapy in OD: no optic disk edema, reduced soft and hard exudates, no flame-shaped hemorrhages, no cotton wool patches. OCT RNFL circle scans, after two months of therapy in OD: decreased edema of all retinal layers, rest of intraretinal and subretinal fluid. OCT, after two months of therapy in OD : decreased edema of all retinal layers, no intraretinal and subretinal fluid. Discussion: Arterial hypertension may cause cerebral, renal, cardiac and retinal end-organ damage. Hypertensive optic neuropathy and optic disk edema leads to hypoxia at the optic nerve head producing proximal axoplasmic flow stasis and secondary axonal swelling. Retinal hypertensive abnormalities are correlated with an increased risk of cardiovascular (CV) disease in general but are not included in cardio vascular risk assessment tools. Kolman et al. (1) evaluated the prevalence of hypertensive retinopathy and the association with other signs of end-organ-damage in 280 patients with arterial hypertension. He found, that in 44% of patients referred to the clinic were diagnosed with hypertensive retinopathy, while 15 and 11% were diagnosed with Left Ventricular Hypertrophy LVH and microalbuminuria, respectively. Patients with isolated hypertensive retinopathy consisted of 31% of all patients. When hypertensive retinopathy was added as a form of end-organ-damage , the percentage of patients with a treatment indication increased from 3 to 14%. Literature: 1) Kolman SA, van Sijl AM, van der Sluijs FA, van de Ree MA. Consideration of hypertensive retinopathy as an important end-organ damage in patients with hypertension. J Hum Hypertens. 2016 Jul 28

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