Optical coherence tomography angiography findings in malignant hypertensive retinopathy

Abstract

A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).

Sensitivity of OCT and OCTA metrics in grading of hypertensive retinopathy

“…OCTA could be used to quantitatively assess the retinal capillary network by employing various metrics such as vessel density and skeletonized vessel density metrics. VD was shown to be lower in hypertensive individuals in previous research, which is consistent with our findings [30,31] . (Dihao et al), found that Hypertensive patients had significantly lower density of vessel in superficial retinal plexus than healthy volunteers [32] .…”

Foveal Avascular Zone in Hypertension as Measured by Optical Coherence Tomography Angiography

“…Although there are studies investigating the relationship of ZAF and hypertension [8,9] to date and the best of our knowoledge, this is the first study to find an increase in FAZ in the superficial plexus in hypertensive patients.…”

“…The foveal avascular zone (FAZ) is a structure sensitive to retinal microvasculature disorders, and may indicate events of ischemic nature [4][5][6][7][8][9][10][11][12]. The imaging gold standard investigation of the retina vascularization is fluorescein angiography, but it is limited in the depth of analyzed structures, viewing only the superficial vascular plexus [13,14].…”