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Abstract：
Objective The objective is to correlate visual outcomes in malignant hypertensive retinopathy with changes in systemic causative factors and spectral domain optical coherence tomography (SD OCT) morphologic parameters. Materials and methods This is a prospective observational study including patients presenting within two weeks of acute rise of systolic blood pressure (SBP) ≥ 180 mm Hg or diastolic blood pressure (DBP) ≥ 120 mm Hg and with posterior segment involvement in both eyes. Baseline SBP, DBP, mean arterial pressure (MAP), best corrected visual acuity (BCVA), and SD OCT parameters such as central macular thickness (CMT), subfoveal choroidal thickness (SCT), and sub-retinal fluid (SRF) height were measured at presentation and followed monthly up to three months. These variables at baseline and three months were compared and correlated. Results Thirty-three patients (66 eyes) having malignant hypertension were included in the study. Diverse clinical presentations noted among patients were optic disc edema, hard exudates in the macula, peripapillary splinter hemorrhage, cotton wool spots, Elschnig spots, exudative retinal detachment, optic neuropathy, and severe exudative retinopathy. SD OCT shows hyperreflective dots and intraretinal fluid with or without SRF. At three months, the mean SBP, DBP, MAP, CMT, SRF, and SCT all decreased significantly from baseline (p<0.001). Changes in SBP, DBP, MAP, and SCT correlated significantly with changes in BCVA (p<0.001). Conclusion In malignant hypertensive retinopathy, macular edema with SRF is the major cause of mild-to-moderate decrease BCVA at presentation, but macular ischemia, exudative RD, and optic neuropathy can cause a significant decrease in vision. A decrease in SBP, DBP, MAP, and SCT correlate significantly with visual outcomes.
摘要：
目的将恶性高血压视网膜病变的视觉结果与全身致病因素和谱域光学相干断层扫描（SDOCT）形态学参数的变化相关联。材料和方法这是一项前瞻性观察性研究，包括在两周内出现收缩压（SBP）≥180mmHg或舒张压（DBP）≥120mmHg且双眼后节受累的患者。基线SBP,DBP,平均动脉压(MAP),最佳矫正视力（BCVA），和SDOCT参数，如中央黄斑厚度（CMT），中央凹下脉络膜厚度（SCT），和视网膜下液（SRF）高度在演示时进行测量，并每月随访3个月。将基线和三个月时的这些变量进行比较和关联。结果33例(66只眼)恶性高血压患者纳入研究。患者中注意到的各种临床表现是视盘水肿，黄斑中的硬渗出物，乳头状碎片出血，棉绒斑点,Elschnig斑点,渗出性视网膜脱离,视神经病变,和严重的渗出性视网膜病变.SDOCT显示有或没有SRF的高反射点和视网膜内流体。三个月后,平均SBP，DBP,MAP,CMT,SRF,和SCT均较基线显著降低(p<0.001)。SBP的变化，DBP,MAP,和SCT与BCVA的变化显着相关（p<0.001）。结论在恶性高血压视网膜病变中,SRF黄斑水肿是BCVA轻度至中度降低的主要原因，但是黄斑缺血,渗出性RD，视神经病变会导致视力明显下降。SBP下降，DBP,MAP,和SCT与视觉结果显著相关。
