Retinal Arteriolar Occlusions and Exudative Retinal Detachments in Malignant Hypertension: More Than Meets the Eye

Retinal vessel wall imaging using fluorescein angiography and adaptive optics imaging in acute branch retinal artery occlusion

PURPOSE

To report the retinal vessel wall changes in a patient with acute branch retinal artery occlusion with fundus fluorescein angiography and adaptive optics imaging.

METHODS

Retrospective, observational case.

CASE DESCRIPTION

A 49-year-old female with cardiac ailment complained of sudden onset superior field loss for 4 days in her right eye. Her presenting visual acuity in the right eye was 20/20, N6. She was diagnosed with right eye infero-temporal branch retinal artery occlusion. A golden-yellow, round coloured embolus was noted on clinical examination obstructing the temporal division of the inferior branch of central retinal artery. Patient underwent ocular massage, anterior chamber paracentesis and oral Acetazolamide (Tab. Diamox 250 mg QID) medications. Vessel wall changes were noted using fluorescein angiography and adaptive optics retinal imaging at presentation and 10-day follow-up visit.

CONCLUSION

This case highlights the importance of multimodal retinal imaging like fluorescein angiography and adaptive optics imaging in identifying and understanding the retinal vessel wall changes in the occluded vascular segment of the retina.

The New Era of Retinal Imaging in Hypertensive Patients

ABSTRACT

Structural and functional alterations in the microcirculation by systemic hypertension can cause significant organ damage at the eye, heart, brain, and kidneys. As the retina is the only tissue in the body that allows direct imaging of small vessels, the relationship of hypertensive retinopathy signs with development of disease states in other organs have been extensively studied; large-scale epidemiological studies using fundus photography and advanced semi-automated analysis software have reported the association of retinopathy signs with hypertensive end-organ damage includes the following: stroke, dementia, and coronary heart disease. Although yielding much useful information, the vessels assessed from fundus photographs remain limited to the larger retinal arterioles and venules, and abnormalities observed may not be that of the earliest changes. Newer imaging modalities such as optical coherence tomography angiography and adaptive optics technology, which allow a greater precision in the structural quantification of retinal vessels, including capillaries, may facilitate the assessment and management of these patients. The advent of deep learning technology has also augmented the utility of fundus photographs to help create diagnostic and risk stratification systems. Particularly, deep learning systems have been shown in several large studies to be able to predict multiple cardiovascular risk factors, major adverse cardiovascular events within 5 years, and presence of coronary artery calcium, from fundus photographs alone. In the future, combining deep learning systems with the imaging precision offered by optical coherence tomography angiography and adaptive optics could pave way for systems that are able to predict adverse clinical outcomes even more accurately.