# Visual Outcomes in Malignant Hypertensive Retinopathy Cases: A Clinical and Spectral Domain Optical Coherence Tomography Study

## TL;DR

This study examines how high blood pressure affects vision in patients with malignant hypertensive retinopathy and how OCT imaging can track these changes.

## Contribution

The study correlates systemic blood pressure changes and OCT parameters with visual outcomes in malignant hypertensive retinopathy.

## Key findings

- Macular edema with sub-retinal fluid is a major cause of mild-to-moderate vision loss at diagnosis.
- Decreases in blood pressure and choroidal thickness correlate with improved visual acuity over three months.
- Macular ischemia, exudative retinal detachment, and optic neuropathy can lead to significant vision loss.

## 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.