First Author: N.Marques PORTUGAL
Co Author(s): S. Barros A. Cardoso J. Cardoso A. Miranda N. Donaire N. Campos 0 0 0 0 0 0 0 0 0
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To elucidate the different ocular manifestations of hypertensive retinopathy and the importance of its recognition
Centro de Responsabilidade de Oftalmologia do Hospital Garcia de Orta
The hypertensive retinopathy is a spectrum of retinal vascular. changes that are related to microvascular damage from elevated blood pressure. It is characterized by arteriolar narrowing, arteriovenous nicking and alterations in the arteriolar light reflex. In sustained hypertension, the inner blood-retinal barrier is disrupted in some areas and causes increased vascular permeability. In this exsudative phase, retinal oedema, retinal haemorrhages may occur. Swelling of optic nerve head is a hallmark for malignant or accelerated hypertension.
First clinical case- 80 years old man, with history of chronic hypertension and renal insufficiency due to hypertension, is referred to our hospital with a rapid and bilateral decrease in visual acuity. At clinical examination, presented a bilateral visual acuity (VA) of counting fingers at 20cm and at fundoscopy, a bilateral and clinical important macular oedema with haemorrhages and silver-wiring of arterioles. Second clinical case- 42 years old man, with history of hypertension not medicated and β-Thalassemia, is referred to our hospital with headache and bilateral decreased VA. At ophthalmological examination, presented a right eye (RE) best corrected VA of 5/10, left eye (LE) best corrected AV of 10/10 and bilateral swelling of the optic disk with haemorrhages, hard exsudates and copper-wiring of the arterioles. The optic coeherence tomography showed a bilateral macular neurossensorial detachment. The patient presented also with concentric heart hypertrophy, renal insufficiency, thrombocytopenia, microangiopathic anemia and arterial tension of 230/150mmHg. After controlling the arterial tension, the optic disk swelling and the neurossensorial detachment disappeared and the RE VA raised to 10/10.
Signs of hypertensive retinopathy are common and correlated with blood pressure levels. Some of these signs are thought to predict stroke and death. For this reason, Patients with this presentation may benefit from close monitoring of cerebrovascular risk and efforts to reduce it.