To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss.
The aim of this study was to determine the prevalence of hypertensive retinopathy, features of hypertensive retinopathy and visual outcome in hypertensive disorders in pregnancy in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. A prospective observational hospital based study involving 154 patients (308 eyes) with hypertensive disorders in pregnancy was conducted. All subjects were examined once during antenatal period, at a minimum of 35 weeks of gestation for blood pressure, visual acuity and funduscopy. The similar protocol was repeated at six weeks postnatal period. Thirty-two point five percent had hypertensive retinopathy. Ninety eight percent had visual acuity 6/6 during antenatal assessment, while 100.00% gained 6/6 at postnatal period. Generalized arteriolar narrowing was the most common retinopathy observed. There was no statistically significant association between presence of hypertensive retinopathy and maternal age, presenting visual acuity, systolic/diastolic blood pressure (p>0.05). We conclude that prevalence of hypertensive retinopathy is 32.5%, and majority had good visual acuity during antenatal and postnatal period. Hypertensive retinopathy is insignificantly associated with maternal age, presenting visual acuity and blood pressure.
Study site: Ophthalmology Clinic, Antenatal Clinic and Obstetric Ward of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
A 23-year-old lady presented with both eye progressive painless blurring of vision for two weeks in 2011. Prior to that she had malar rash, hair loss, photosensitivity and bilateral leg swelling. Ocular examination showed that visual acuity on the right was 6/60 and on the left was 6/24. Both optic disc were swollen with extensive peripapillary cotton wool spot (CWS), flame shape haemorrhages, dilated and tortuous vessels with macular oedema. Systemic examination revealed blood pressure of 176/111 mmHg, malar rash and alopecia. Diagnosis of grade 4 hypertensive retinopathy secondary to SLE was made. The diagnosis was confirmed by positive ANA/ dsDNA, low C3/ C4 and renal biopsy showed lupus nephritis. She was treated with oral prednisolone, hydroxychloroquine and cyclosporin A. Throughout the monitoring for hydroxychloroquine toxicity, vision over both eyes were 6/9, but serial visual fields showed non-progressive left superior and inferior scotoma while right eye showed inferior scotoma. The intraocular pressure was normal with pink optic disc and cup disc ratio of 0.3. Optical coherence tomography (OCT) showed temporal and nasal retinal nerve fiber layer thinning bilaterally. However, macula OCT, fundus fluorescein angiography and autofluorescence were normal. The visual field defect was concluded secondary to CWS indicating microinfarction of the retinal nerve fiber secondary to previous hypertensive retinopathy. Non-progressive visual field defects may occur after the appearance of CWS in hypertensive retinopathy and it should not be overlooked when diagnosing glaucoma or hydroxychloroquine toxicity.