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1、HYPERTENSIVE RETINOPATHY,DR AJAY DUDANI DR YASHESH MANIAR,- MANY CAUSES - MAINLY ESSENTIAL HYPERTENSION,SYSTEMIC HYPERTENSION (JNCV 5TH),STATE OF PERSISTENT ELEVATED BLOOD PRESSURE ABOVE 140/90 mmHg.,5TH JOINT NATIONAL COMMITTEE CLASSIFICATION OF BLOOD PRESSURE,CATEGORY SYSTOLIC BP DIASTOLIC BP(mmHg
2、) (mmHg),NORMAL 210 120,PATHOPHYSIOLOGICAL CHANGES IN HYPERTENSIVE OCULAR DISEASE,HYPERTENSIVE CHOROIDOPATHY HYPERTENSIVE RETINOPATHY- VASOCONSTRICTIVE PHASE- SCLEROTIC PHASE- EXUDATIVE PHASE- COMPLICATIONS OF THE SCLEROTIC PHASE 3. HYPERTENSIVE OPTIC NEUROPATHY- OPTIC DISC EDEMA- OPTIC ATROPHY- ISC
3、HEMIC OPTIC NEUROPATHY,OCULAR HYPERTENSION,ARTERIOSCLEROSIS,GRADE 0 NORMAL GRADE 1 INCREASED LIGHT REFLEX, WITH MILD ARTERIOVENOUS CROSSING DEFECTS GRADE 2 COPPER WIRE APPEARANCE GRADE 3 SILVER WIRE APPEARANCE, WITH MARKED ARTERIO VENOUS CROSSING DEFECTS GRADE 4 FIBROUS CORD,Grading of arterioloscle
4、rosis,OCULAR HYPERTENSION,ARTERIOLES,A-V RATIO FOCAL SPASM GRADE 0 3:4 1:1 GRADE 1 1:2 1:1 GRADE 2 1:3 2:3 GRADE 3 1:4 1:3 +/- C W SPOT GRADE 4 FIBROUS CORD NO DISTAL FLOW +/-ELS SPOT,HYPERTENSIVE RETINOPATHY,HEMORRHAGE EXUDATE DISC EDEMA,GRADE 0 - - - GRADE 1 - - - GRADE 2 - - - GRADE 3 + + - GRADE
5、 4 + + +,GRADE 1 HTR,GENERALIZED ARTERIOLAR ATTENUATION BROADENING OF ARTERIOLAR LIGHT REFLEX CONCEALMENT OF VEIN AT A-V CROSSINGS,GRADE 2 HTR,SEVERE GENERALIZED AND FOCAL ARTERIOLAR CONSTRICTION A-V CROSSING CHANGES (SALUS SIGN),GRADE 3 HTR,Copper wiring of arterioles Venous banking distal to A-V c
6、rossing (bonnets sn) Venous tapering on either side of crossing (gunns sn) Right angle deflection of veins. Flame shaped hemorrhages cotton wool spots, hard exudates.,GRADE 4 HTR,All changes of grade 3Silver wiring of arteriolesDisc edema,Ocular associations of hypertension,Retinal vein occlusion,CR
7、VO (Central Retinal Vein Occlusion)HRVO (Hemi Retinal Vein Occlusion)BRVO (Branch Retinal Vein Occlusion) Constitutes 69.5 % of all RVO cases,CRVO .,Classic Appearance,Mildest Form,CRVO,NON ISCHAEMIC,ISCHAEMIC,62/F PR No 17474 CRVO,IVTA(elsewhere),Baseline 20/500,3 weeks 20/500,3 months 20/200,62/F
8、PR No 17474 CRVO (S/P IVTA),2nd IVTA,5 months 20/400,8 months 20/100,Avastin,2nd Avastin,Hayreh et al Non Ischaemic : Due to simple occlusion of retinal venous system Ischaemic : Due to combined occlusion of the arterial & venous circulationGreen et al Thrombus formation in the region of lamina crib
9、rosa is the primary event,CRVO,Complications / Sequelae .,Macular oedema Haemorrhage Ischaemia stimulates neovascularization in Optic disc Retina Angle Iris - Rubeosis may cause Neovascular Glaucoma Rhegmatogenous RD Vascular complications Microaneurysyms Optociliary vessels collaterals between reti
10、nal & ciliary vessels,CRVO,Cilioretinal artery occlusion,Combined with CRVO,Cilioretinal artery occlusion,Combined with anterior ischaemic optic neuropathy,HRVO .,HRVO .,Superior & Inferior vein do not merge into Central Vein before entering into lamina cribrosa Like CRVO, only superior or inferior
11、half involved Types 2/3rd : Venous stasis 1/3rd : Haemorrhagic Rest Rx or management same as CRVO,BRVO .,45/M PR No 17422 BRVO,Baseline 20/500 STT,3 weeks 20/500 Avastin,6 weeks/8 m 20/80,45/M PR No 17422 BRVO,BRVO,BRVO .,Portion of retina involved Mostly temporal - 62% Superotemporal 38% Inferotemp
12、oral Nasal uncommon & asymptomatic Occurs exclusively at arterial overcrossing at AV intersection by a thrombus,Investigations in RVO .,Hb/CBC/ESR/Platelet count BSL Fasting/PP BP Sr. Lipid Profile IOP Measurement FFA ANA/Anti-ds DNA VDRL/FTA-Abs LE Cell,In Young .,Protein C levels Protein S levels
13、Platelet Analysis Sr. & Urine for Homocysteine levels,Others .,Hb Electrophoresis PT / PTT Anti-Phospholipid antibody Complete Cardiovascular evaluation,Traditional Rx Options .,To treat the associated systemic diseases (Medical Rx)To treat the ocular complications(Laser or Sx)- CRVO Study Group- BRVO Study Group,Retinal artery macroaneurysm,Ocular associations of hypertension,Anterior ischaemic optic neuropathy,Ocular associations of hypertension,Ocular motor nerve palsies,Ocular associations of hypertension,
