Purchase this article with an account.
R.L. Kramm, A.P. Ciardella; Neurosensory Detachment in Hypertensive Retinopathy Demonstrated by Optical Coherence Tomography: A Case Series . Invest. Ophthalmol. Vis. Sci. 2005;46(13):264.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe a series of ten patients with acute malignant hypertension and neurosensory retinal detachments demonstrated by Optical Coherence Tomography. Specifically, we present the bilateral nature of the findings, resolution confirmed by subsequent OCT, impact on visual acuity, proximity to fovea, and correlation to degree of hypertensive retinopathy using the Modified Scheie Classification. Also discussed are concomitant fluorescein angiography findings and the often occult nature of the detachments in this setting. Methods: Patients whom were admitted with the diagnosis of malignant hypertension were fully evaluated with a complete ophthalmologic exam including fundus photographs, fluorescein angiography, and OCT. Several patients had a subsequent OCT to document resolution or persistence of the neurosensory detachment at a later date. Results: Serous neurosensory macular detachment was a common finding by OCT during hypertensive crisis. The serous neurosensory macular detachment was found to be more frequent, when we looked for it systematically with OCT scans of the macula, than what we suspected by clinical examination only. Resolution of the hypertensive crisis was associated with resolution of the serous neurosensory macular detachment. Conclusions: Malignant or accelerated hypertension can be defined as rapidly progressive renal failure in the presence of moderate or severe hypertension, and is often associated with grade 3 or grade 4 hypertensive retinopathy. The ophthalmologic manifestations of hypertensive retinopathy are well described in the literature, and include retinal arteriolar narrowing, retinal hemorrhages, nerve–fiber layer infarcts, retinal vein or artery occlusion, and optic nerve head swelling. Rarely described in the literature are focal retinal pigment epithelium detachments and associated exudative neurosensory detachments in this setting. The more recent utilization of optical coherence tomography has allowed the detection of clinically occult serous elevations of the retina. Following normalization of blood pressure, detachments secondary to malignant hypertension usually resolve within a few weeks; however, these patients may be left with extensive degenerative changes of the RPE, resulting in permanent visual loss despite resolution of the retinal detachment. Based on our experience, there is a subset of acutely hypertensive patients with neurosensory detachments best (and sometimes only) appreciated using OCT.
This PDF is available to Subscribers Only