Retinal and choroidal changes with severe hypertension and their association with visual outcome

To investigate retinal and choroidal changes using spectral-domain optical coherence tomography (SD-OCT) and to evaluate visual outcome in patients with severe hypertension.

In 42 eyes with hypertensive retinopathy from 21 patients with severe hypertension (systolic blood pressure [SBP] ≥ 180 mm Hg or diastolic blood pressure [DBP] ≥ 110 mm Hg), SD-OCT was performed on the day blood pressure (BP) was measured. Best-corrected visual acuity (BCVA), fundus features, and SD-OCT morphologic findings were evaluated and OCT features were compared between baseline and final visits. Associations between clinical findings, OCT image features, and Keith-Wagener-Barker (KWB) hypertensive retinopathy grades and baseline and final BCVA were examined.

Optical coherence tomography findings included macular edema (central macular thickness > 300 μm), irregularly reflective regions, retinal nerve fiber layer thickening, subretinal fluid (SRF), intraretinal fluid, and intraretinal hyperreflective dots. All abnormalities rapidly resolved with BP control except for the hyperreflective dots. Central macular thickness, subfoveal choroidal thickness (SCT), and SRF height significantly decreased following BP control. Subretinal fluid height was significantly correlated with baseline BCVA, final BCVA, and SCT. Based on fundoscopic and OCT features, eyes were classified as showing mild to moderate retinopathy, malignant retinopathy without SRF, and malignant retinopathy with SRF. Unlike KWB grades (P = 0.077), the OCT-based retinopathy grades were significantly correlated to final BCVA, as shown by linear regression analyses (P = 0.025).

Severe hypertension resulted in exudative retinal and choroidal changes, characterized by SRF accumulation and increased SCT. Our grading system may represent retinopathy severity and predict visual outcome better than the KWB grading system in patients with severe hypertension.