HYPERTENSIVE RETINOPATHY

Hypertension or high blood pressure can lead to a variety of health problems, including retinal damage through ischemia. Depending on the patient’s retinal condition, hypertension could lead to vision loss if left untreated. Treatments that assist in the regression of the disease include intraocular injections of Kenalog and grid laser treatments. For the most part however, it is the effectiveness of the hypertension treatment that ultimately decides whether or not the patient suffers from ocular complications.

WHAT IS THE CONDITION?

When a patient has chronic hypertension, it means that their blood vessels are experiencing a greater amount of stress due to increased blood volume or decreased vessel space. The subsequent increase in pressure on blood vessel walls due to hypertension causes them to weaken and eventually break. This progressive weakening and leaking of blood vessels can occur anywhere in the body, including the retina.

Initially, the leakage of blood simply fills the vitreous body, which blocks light from reaching the retina and impairs vision. Prolonged bleeding, however, leads to ischemia (impaired perfusion and delivery of blood and nutrients) wherein the retinal cells absorb blood and are thus unable to receive cell nutrients and dispose cell wastes from the blood stream. The retina can become subsequently edematous (swollen) causing further decline of retinal nerve cells.

In addition to the fact that ischemia can cause retinal cells to die leading to permanent vision loss, the macula or central retina can become infected in the form of white wooly spots, or “cotton wool spots”. These spots represent excessively elevated blood pressure and chornic ischemia. The swelling of retinal cells or macular edema due to the absorption of blood and infection can seriously damage a patient’s central vision if left untreated.

PROGNOSIS

The macular edema that is seen in patients who have excessively elevated high blood pressure is generally resolved by simply treating the underlying hypertension. Unfortunately, resolving the macular edema can take several months before complete resolution is seen. In this time period, there can be residual exudates or fat deposits accumulating in the retina. Despite complete resolution of edema, there may be persistent visual loss due to the ischemia that caused persistent cell death in the retina.

TREATMENT

The first step to treating ocular complications caused by hypertension is to treat the hypertension itself. By working to reduce blood pressure with their physician, patients can successfully decrease their blood pressure and eliminate the ocular side effects of hypertension. Even bleeding within the eye is expected to fade away within a year if the patient manages to decrease their blood pressure to healthy levels. Meanwhile, it is vital for an ophthalmologist to carefully monitor a patient’s retinal conditions through methods such as OCT testing, fluorescein angiography, and microperimetry.

INTRAOCULAR KENALOG & RETINAL LASER

By regularly observing the patient’s retinal condition, an ophthalmologist is able to employ grid thermal laser treatments and intraocular injections of Kenalog to prevent retinal damage. Grid laser treatments stem retinal blood vessel leakage, while Kenalog is an anti-inflammatory substance that can be intraocularly injected to reduce macular edema. Both are effective tools in preserving the health of retinal cells. However, if these two preventative treatments prove ineffective, and the patient’s blood pressure is not lowered in time, ischemia can lead to the death of retinal cells and thus the partial loss of a patient’s vision.