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      Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography : Case report

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          Abstract

          Rationale:

          To investigate malignant hypertension ocular lesions with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCT-A).

          Patient concerns:

          Visual loss due to malignant hypertension.

          Diagnoses:

          Hypertensive chorioretinopathy.

          Interventions:

          Patients were thoroughly examined on presentation and 30 days after their first visit, with swept-source optical coherence tomography and optical coherence tomography angiography.

          Outcomes:

          Lesions were totally absorbed during the follow-up time. Additionally, they presented fibrin deposits, as multiple solid hyper-reflective structures overlying retinal pigment epithelium, on both—SS-OCT and OCT-A. The last were still detected even larger in size at the last visit of the patients.

          Lessons:

          These novel imaging examinations allow the ophthalmologist to detect in detail the several clinical manifestations of malignant hypertension on the fundus, and draw useful conclusions about their peculiar pathogenesis.

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          Most cited references20

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          Pathophysiology of hypertensive retinopathy.

          The effects of systemic hypertension on the posterior segment of the eye are discussed under the headings of hypertensive choroidopathy, hypertensive retinopathy, and hypertensive optic disc edema. The sympathetic nervous control and autoregulatory mechanisms of the retinal and choroidal vasculatures are briefly reviewed. In hypertensive choroidopathy focal occlusion of choriocapillaris leads to necrosis of retinal pigment epithelium (Elschnig spots). Hypertensive retinopathy is described in vasoconstrictive, exudative, and sclerotic phases, followed by complications of the sclerotic phase. Hypertensive optic disc edema is influenced by the blood supply and extracellular tissue fluid pressure of the optic nervehead. In baboons with hypertensive disc edema, accumulation of axoplasmic components is observed in the optic nervehead.
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            Fundus lesions in malignant hypertension. VI. Hypertensive choroidopathy.

            Experimental renovascular malignant arterial hypertension was produced, by modified Goldblatt's procedures, in 60 rhesus monkeys, and hypertensive fundus changes were studied in detail (by serial ophthalmoscopy and fluorescein fundus angiography in all monkeys on a long-term follow-up, and pathologically in 29 eyes). In hypertensive choroidopathy, retinal pigment epithelial (RPE) lesions and serous retinal detachment (RD) were the classic ophthalmoscopic lesions, whereas fluorescein fundus angiography and histopathologic studies revealed marked abnormalities in the choroidal vascular bed, in addition to the changes in the RPE. The RPE lesions could be subdivided into initial acute focal lesions (due to focal RPE infarction), and degenerative lesions, which developed later and were progressive in nature, maximally involving the macular and peripheral regions of the fundus. The RD developed most commonly in the posterior pole and infrequently involved the peripheral retina. The choroidal vascular bed showed impaired circulation and extensive occlusive and ischemic changes. These studies revealed that hypertensive choroidopathy is as important a fundus change as hypertensive retinopathy. The pathogenesis of hypertensive choroidopathy is discussed in detail; the evidence indicates that it is due to choroidal ischemia, and that hypertensive choroidopathy and retinopathy are two independent and unrelated manifestations of renovascular malignant hypertension.
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              Retinal Arteriolar Changes in Malignant Arterial Hypertension

              Experimental renovascular malignant arterial hypertension was produced by modified Goldblatt’s procedures, in 60 rhesus monkeys, and various retinal arteriolar changes in hypertensive retinopathy were studied in detail (by serial ophthalmoscopy, and stereoscopic color fundus photography and fluorescein fundus angiography on long-term follow-up). The retinal arteriolar changes, in ophthalmoscopically visible arterioles, consisted of arteriolar sclerosis and associated changes, e.g., increased arteriolar tortuosity, arteriolar narrowing and in some animals occlusion and sheathing of the fine arterioles; we could find no evidence of localized or generalized ‘spasm’ in these retinal arterioles. Eyes in animals with accelerated arterial hypertension revealed focal dilatation and leakage of the retinal precapillary terminal arterioles (resulting in development of focal intraretinal periarteriolar transudates), and also occlusion of the terminal retinal arterioles (producing cotton-wool spots and associated intraretinal microvascular abnormalities). We discuss the controversial subjects of narrowing (particularly ‘spasm’) of ophthalmoscopically visible retinal arterioles and of fibrinoid necrosis in malignant hypertension.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2017
                29 September 2017
                : 96
                : 39
                : e8110
                Affiliations
                [a ]A’ Department of Ophthalmology, University of Athens, General Hospital of Athens, Athens, Greece
                [b ]Moorfield's Eye Hospital, London, UK.
                Author notes
                []Correspondence: Konstantinos Andreanos, 22str Digeni E.O.K.A, Nea Penteli, Athens 15236, Greece (e-mail: coandre80@ 123456icloud.com ).
                Article
                MD-D-17-03876 08110
                10.1097/MD.0000000000008110
                5626277
                28953634
                796d4527-79fe-4bdd-85c3-7a4bf9d12c6f
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 23 June 2017
                : 24 August 2017
                : 1 September 2017
                Categories
                5800
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                chorioretinopathy,elsching spots,malignant hypertension,optical coherence tomography angiography,swept-source oct

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