๐๐๐ฝ๐ฒ๐ฟ๐๐ฒ๐ป๐๐ถ๐๐ฒ ๐ฅ๐ฒ๐๐ถ๐ป๐ผ๐ฝ๐ฎ๐๐ต๐โฃ
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The arteriosclerotic changes in HTN Retinopathy is due to chronically elevated blood pressure >140/90mmHgโฃ
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๐ฆ๐๐ฎ๐ด๐ฒ๐:โฃ
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1. ๐๐ข๐ด๐ฐ๐ค๐ฐ๐ฏ๐ด๐ต๐ณ๐ช๐ค๐ต๐ช๐ฐ๐ฏ โ Vasospasm and increase in tone of retinal arteries โ Generalised arterial narrowingโฃ
2. ๐๐ค๐ญ๐ฆ๐ณ๐ฐ๐ต๐ช๐ค stage โ Persistent elevation of BP โ Intimal artery thickening, hyperplasia of media wall and hyaline degeneration โ Severe generalised and focal areas of arterial narrowing, AV nicking, widening of central arteriolar light reflexโฃ
3. ๐๐น๐ถ๐ฅ๐ข๐ต๐ช๐ท๐ฆ โ Disruption of blood retinal barrier, necrosis of smooth muscles cells and endothelial cells โ hemorrhages, hard exudates, cotton wool spotsโฃ
4. ๐๐ข๐ญ๐ช๐จ๐ฏ๐ข๐ฏ๐ต ๐๐บ๐ฑ๐ฆ๐ณ๐ต๐ฆ๐ฏ๐ด๐ช๐ฐ๐ฏ/ ๐๐บ๐ฑ๐ฆ๐ณ๐ต๐ฆ๐ฏ๐ด๐ช๐ท๐ฆ ๐๐ฑ๐ต๐ช๐ค ๐๐ฆ๐ถ๐ณ๐ฐ๐ฑ๐ข๐ต๐ฉ๐บ โ ICP elevated with effects on optic nerve โ optic nerve ischemia, papilledema. Serous detachments can occur.โฃ
5. ๐๐บ๐ฑ๐ฆ๐ณ๐ต๐ฆ๐ฏ๐ด๐ช๐ท๐ฆ ๐๐ฉ๐ฐ๐ณ๐ฐ๐ช๐ฅ๐ฐ๐ฑ๐ข๐ต๐ฉ๐บ โ Choroidal arteries โ Fibrinoid necrosis โ โElschingโs spotsโ (patches of RPE appearing yellow due to infarction of segments of choriocapillaries) โ hyperpigmented with a margin of hypopigmentation as they resolve. Linear RPE Hyperplasia over infarcted choroidal arterioles โโ Siegristโs Streaksโฃ
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Classifications - Shown on pictures โฃ
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๐ ๐ฎ๐น๐ถ๐ด๐ป๐ฎ๐ป๐ ๐๐๐ฝ๐ฒ๐ฟ๐๐ฒ๐ป๐๐ถ๐ผ๐ป/ Accelerated Hypertension is used to describe sudden increase in blood pressure >180/120mm Hgโฃ
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๐ฆ๐ถ๐ด๐ป๐:โฃ
โ Papilledema - due to ischemia of axons(1)โฃ
โ Constricted and tortuous retinal arterioles (5)โฃ
โ Retinal hemorrhages especially flame shaped hemorrhages (2)โฃ
โ Cotton wool spots (3)โฃ
โ Hard exudates (4) (Macular star can be present)โฃ
โ Retinal edemaโฃ
โ Choroidopathy - fibrinoid necrosis of choroidal vesselsโฃ
โ Macular serous retinal detachment - possible markerโฃ
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Others related to Hypertension:โฃ
1. Anterior ischemic optic neuropathy (AION)โฃ
2. Retinal macroaneurysmsโฃ
3. Retinal vein occlusionsโฃ
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๐ ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐โฃ
โ Reduction of blood pressure with antihypertensive drugs is the mainstayโฃ
โ Management of ischemic sequelae by PRP/Anti VEGFsโฃ
โ Rule out secondary causes of malignant hypertensionโฃ
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