Title

HYPERTENSIVE RETINOPATHY MIMICKING DIABETIC RETINOPATHY.

Summary

A 62-year-old male was referred to the Retina Department presenting a gradual visual loss in both eyes. From his past medical history, he had a history of hypertension, stage 5 chronic kidney disease; obstructive pulmonary disease, congestive heart failure and alcoholism. He was not taking his medications correctly. At the time oft his first visit, his Snellen best-corrected visual acuity was CF 4M in the right eye (RE) and 20/70 in the left eye (LE). Slit-lamp examination was unremarkable. Fundus examination revealed arteriolar changes. In the left eye, the fundoscopy exam showed a temporal inferior macroaneurysm. Fluorescein angiography demonstrated capillary non-perfusion, hypofluorescence of the retinal hemorrhages and the presence of microaneurysms. On optical coherence tomography, macular scanning showed a macular edema in both eyes. At this point, his blood pressure was 180x110mmhg and he underwent treatment of his systemic diseases. The patient did not attended the appointments that were schedule, and then, he was referred again to our ambulatory 6 months later. In this moment, his blood pressure was under control. The AGF showed a vascular leakage in the left eye. OCT demonstrated macular edema in the right eye and disruption of the outer retina of the LE. An extensive patient investigation did not reveal any secondary causes for his proliferative retinopathy. Studies with normal results included infectious diseases, hemoglobin electroforesis, coagulopathies, reumatologic tests and hemoglobin A1c measurement (5.3%). Conclusion: Hypotheses of chronic hypertensive retinopathy; proliferative retinopathy; enlargement of foveal avascular zone, capillary non-perfusion areas and macular edema in the right eye were made. We treated our patient with panfotocoagulation and intravitreous Anti-Vegf. Hypertensive retinopathy can be rarely complicated with retinal neovascularization, there are just 3 related cases in the literature, this should be the fourth one.

Area

CLINICAL CASE

Authors

Livia Garcia Biselli, Sérgio Gianotti Pimentel, Cleide Guimarães Machado, Camila Sayuri Vicentini Otani, Livia da Silva Conci, Felipe Ribeiro de Souza, Renato Rodrigues Pereima