恶性高血压性视网膜病变眼底影像学特点

Fundus imaging characteristics of malignant hypertensive retinopathy

目的 观察恶性高血压性视网膜病变的眼底影像学特点。方法 回顾性分析于2011年1月至2023年10月就诊于山东第二医科大学附属医院眼科的恶性高血压患者的眼底影像学特点。14例恶性高血压患者(28只眼)为观察组,14例普通高血压患者(28只眼)为对照组。收集所有患者的眼底照相、光学相干断层扫描(OCT)、眼底荧光血管造影(FFA)等临床资料,分析总结恶性高血压性视网膜病变的眼底影像学特征。结果 观察组男性12例,女性2例,平均年龄为(36.0±8.9)岁,平均收缩压为(207.0±20.0)mmHg,平均舒张压为(136.6±12.1)mmHg, 14例患者均以视力下降为主要临床症状首诊于眼科,且既往无明确的高血压病史。眼底照相主要表现为:视网膜点片状出血,棉绒斑,黄斑区星芒状硬性渗出,视盘水肿。OCT主要表现为:视网膜下积液,视网膜内积液,神经上皮层团块状高反射,色素上皮层点状高反射。FFA主要表现为:视盘渗漏高荧光,出血、棉绒斑呈低荧光,视网膜点片状透见高荧光,圆形积存高荧光。结论 恶性高血压性视网膜病变眼底表现主要为:视网膜出血,硬性渗出,棉绒斑,视网膜积液,视盘水肿,且双眼发病,临床中遇到以上临床特征,应高度警惕恶性高血压,以免漏诊误诊。

Objective To observe the fundus imaging features of malignant hypertensive retinopathy.Methods The fundus imaging features of all patients with malignant hypertension who were admitted to Affiliated Hospital of Shandong Second Medical University from January 2011 to October 2023 were analyzed retrospectively.Fourteen patients(28 eyes)with malignant hypertension were in the observation group and 14 patients(28 eyes)with common hypertension were in the control group.The clinical data of fundus photography,optical coherence tomography(OCT),and fundus fluorescein angiography(FFA)were collected to analyze and summarize the fundus imaging features of malignant hypertensive retinopathy.Results The 14 patients(12 males and 2 females)in malignant hypertension group had an average age of(36.0±8.9)years,mean systolic blood pressure of(207.0±20.0)mmHg,and mean diastolic blood pressure of(136.6±12.1)mmHg.All 14 patients were first visited in ophthalmology with visual acuity loss as the main clinical symptom,and had no history of hypertension.The main manifestations of fundus photography were as follows:hemorrhage,cotton velvet spot,macular awn-like rigid exudation,and optic papilla edema.The main manifestations of OCT were subretinal fluid,intraretinal fluid,massive high reflex in the inner layer of the retina,and punctate high reflex in the pigment epithelium.The main manifestations of FFA were as follows:high fluorescence of the optic papilla,low fluorescence of hemorrhage,punctate high fluorescence of the retina,and round accumulation of high fluorescence.Conclusions The main fundus manifestations of malignant hypertensive retinopathy are retinal hemorrhage,exudation,cotton velvet spot,serous retinal edema,optic papilla edema,and the onset of both eyes.When encountering the above clinical features,we should be highly vigilant against malignant hypertension to avoid missed diagnosis and misdiagnosis.