RETINAL VASCULAR IMPACT IN SYSTEMIC HYPERTENSION. CASE REPORT

  • Cristina MANOLE “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest
  • Bogdana TABACARU “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest
  • C. DANIELESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • H.T. STANCA “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest

Abstract

We report a case of malignant systemic hypertension in the context of a multifactorial association (chronic kidney disease, hereditary thrombophilia, autoimmune thyroiditis, hyperaldosteronism, infectious optic neuritis) with ophthalmological onset symptoms only, highlighting the interrelationship between the retinal vascular impact and systemic hypertension, as well as between the systemic hypertension and the patient's underlying diseases. The paper presents the case of a 40-year-old female who complained of sudden loss of visual acuity in both eyes. The ophthalmological examination was suggestive for hypertensive neuroretinopathy, but the management of diagnosis and therapy was particularly difficult in the absence of systemic complaints and low patient compliance for a long time regarding the complementary interdisciplinary consultations that were recommended by the ophthalmologist. Confirmation of the diagnosis of hypertensive neuroretinopathy was possible only late in the evolution of the disease, with the appearance of systemic complications of hypertension such as: encephalopathy, cardiomyopathy, and nephropathy. In this context, a plurietiologic determinism was identified: chronic kidney disease, autoimmune thyroiditis, hyperaldosteronism, hereditary thrombophilia, and infectious optic neuritis. The ophthalmologic condition began to evolve favorably anatomically and functionally only after the establishment of pathogenic treatment. In conclusion, we are faced with a complex case that requires a multidisciplinary approach to assess a wide range of diseases, which analyzed separately, can have retinal vascular impact.

Author Biographies

Cristina MANOLE, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest

Department of Clinical Ophthalmology

Bogdana TABACARU, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest

Department of Clinical Ophthalmology
“Carol Davila” University of Medicine and Pharmacy Bucharest
Faculty of Medicine
Department of Ophthalmology

C. DANIELESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (II

H.T. STANCA, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest

Department of Clinical Ophthalmology
“Carol Davila” University of Medicine and Pharmacy Bucharest
Faculty of Medicine
Department of Ophthalmology

References

1. Dorobantu M, Tautu OF, Dimulescu D, Sinescu C, Gusbeth-Tatomir P, Arsenescu-Georgescu C, et al. Perspectives on hypertension’s prevalence, treatment, and control in a high cardiovascular risk East European country: data from the SEPHAR III survey. J Hypertens 2018; 36: 690-700.
2. Grosso A, Veglio F, Porta M, Grignolo FM, Wong TY. Hypertensive retinopathy revisited: some answers, more questions. Br J Ophthalmol. 2005; 89(12): 1646-1654.
3. Bowling B. Kanski’s Clinical Ophthalmology, A Systematic Approach. 8th edition, Elsevier Limited, 2016, 557-559, 779-806.
4. Khurana K. Comprehensive Ophthalmology. 4th edition, New Age Publishers, 2007, 257-259.
5. Garner A, Ashton N, Tripathi R, Kohner EM, Bulpitt CJ, Dollery CT. Pathogenesis of hypertensive retinopathy. An experimental study in the monkey. Br J Ophthalmol 1975; 59(1): 3-44
6. Benken ST. Hypertensive emergencies. Medical Issues in the ICU. CCSAP 2018. https://www.accp.com/docs/bookstore/ccsap/ccsap2018b1_sample.pdf
7. Gebbers JO. Atherosclerosis, cholesterol, nutrition, and statins-a critical review. Ger Med Sci 2007; 5: Doc04.
8. Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol 2012; 4(5): 135‐147.
9. Ryan SJ. Retinal Vascular Disease, Springer, 2007, 139-153, 443-506, 688-699.
10. Yanoff M, Lehman A, Spector R, et al. Ophthalmology. 3rd edition, London: JP Medical Ltd, Hyper-tensive retinopathy, 2014, 236-237.
11. Jackson TL. Moorfields Manual of Ophthalmology. London: JP Medial Ltd, 2014, 493-494, 660-664, 670-686.
12. https://eyewiki.aao.org/Hypertensive_retinopathy
13. Culea C, Tăbăcaru B, Stanca TH. Bilateral papillary oedema case report. Rom J Ophthalmol 2018; 62(2): 166‐174.
14. Bienfang DC (2019). Overview and differential diagnosis of papilledema. https://www.uptodate.com/contents/overview-and-differential-diagnosis-of-papilledema#H21
15. Stanca HT, Suvac E, Munteanu M, et al. Giant cell arteritis with arteritic anterior ischemic optic neuropathy. Rom J Morphol Embryol 2017; 58(1): 281-285.
16. David C, Suvac E, Tăbăcaru B, Stanca TH. Pseudo-Foster Kennedy Syndrome-a case report. Rom J Ophthalmol 2016; 60(4): 270‐274.
17. Bordas M, Tabacaru B, Stanca TH. Non-arteritic anterior ischemic optic neuropathy - Case report. Rom J Ophthalmol 2018; 62(3): 231‐245.
18. Denniston AKO, Murray PI. Oxford Handbook of Ophthalmology. 3rd edition, Oxford University Press, 2014, 564-565, 658-685.
19. Stanca, HT, Petrović Z, Munteanu M. Transluminal Nd: YAG laser embolysis - a reasonable method to reperfuse occluded branch retinal arteries. Vojnosanit Pregl 2014; 71(11): 1072-1077.
20. Arriozola-Rodríguez KJ, Serna-Ojeda JC, Martínez-Hernández VA, Rodríguez-Loaiza JL. Hyperten-sive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case. Case Rep Ophthalmol 2015; 6(3): 415-419.
21. Henderson AD, Biousse V, Newman NJ, Lamirel C, Wright DW, Bruce BB. Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure. West J Emerg Med 2012; 13(6): 529-534.
22. Michelli A, Bernardi S, Grillo A, et al. A case report of malignant hypertension in a young wom-an. BMC Nephrol 2016; 17(1): 65.
23. Textor S, Bakris GL, Elliott WJ (2020). Evaluation of secondary hypertension. https://www.uptodate.com/contents/evaluation-of-secondary-hypertension?search=Evaluation%20 of%20secondary%20hypertension&source=search_result&selectedTitle=1~150&usage_type=
Default & display_rank=1
24. Dixon SG, Bruce CT, Glueck CJ, et al. Retinal vascular occlusion: a window to diagnosis of familial and acquired thrombophilia and hypofibrinolysis, with important ramifications for pregnancy out-comes. Clin Ophthalmol 2016; 10: 1479-1486.
25. Savoiu Balint G, Iovanescu G, Stanca HT, Popoiu CM, Boia E, Popovici AR, Bolintineanu SL. The Protective Effect of HDL-Cholesterol in Patients with Essential Hypertension. Rev. Chim (Bucharest) 2017; 68(5): 949-952.
26. Glueck CJ, Hutchins RK, Jurantee J, Khan Z, Wang P. Thrombophilia, and retinal vascular occlusion. Clin Ophthalmol 2012; 6: 1377-1384.
27. Danzi S, Klein I. Thyroid hormone and blood pressure regulation. Current Science Inc 2003; 5: 513-520.
28. Berta E, Lengyel I, Halmi S, et al. Hypertension in Thyroid Disorders. Front Endocrinol (Lausanne) 2019; 10: 482.
29. Krysiak R, Okopien B. Coexistence of primary aldosteronism and Hashimoto’s thyroiditis. Rheumatol Int 2012; 32(8): 2561-2563.
30. Kahloun R, Abroug N, Ksiaa I, et al. Infectious optic neuropathies: a clinical update. Eye Brain 2015; 7: 59-81.
31. Anton N, Alexa AI, Cantemir A, Ciuntu BM, Timofte DV, Bodanici MC, Ciuntu RE. The Importance of Specific Antibiotic Therapy in the Evolution of Retinal Vasculitis. Rev. Chim (Bucharest) 2017; 68(9): 2088-2091.
Published
2020-12-23