Hypertensive crisis with massive retinal and choroidal infarction: A case update

Abstract

PurposeWe report an update on a recently published case of uncontrolled hypertension secondary to immunoglobulin A (IgA) nephropathy resulting in massive bilateral retinal and choroidal infarction.ObservationsIn our previous report, we presented a 30-year old female with end-stage renal disease who complained of painless vision loss after many missed hemodialysis. The patient was found to be in hypertensive crisis resulting in massive retinal and choroidal infarction with severe vision loss in both eyes. The patient was treated with pan-retinal photocoagulation (PRP) with intravitreal Bevacizumab and was subsequently lost to follow-up. In this update, we report the complications that followed. After many months, she presented to clinic with a blind painful right eye. She was found to have a further decrease in vision with neovascular glaucoma in the right eye and a tractional retinal detachment in the left eye. The patient ultimately elected for enucleation of her right eye. Immunohistopathology revealed IgA deposition, confirming the presumed diagnosis of IgA nephropathy, previously unconfirmable through renal biopsy.Conclusions and ImportanceThere is a strong association between severity of retinopathy and level of kidney function. Although a rare presentation, hypertensive retinopathy is a common complication of end-stage renal disease and can be a devastating process as emphasized by this report. Those with auto-immune renal disease, such as IgA nephropathy, are at higher risk for retino-choroidal complications. It should remind all ophthalmologists and clinicians on the necessity of closer eye examinations for these patients, particularly for those with auto-immune renal disease.

Hypertension as an Unusual Cause of Proliferative Retinopathy: Case Report and Literature Review

“…We included all articles in the English literature trying to explore this unique association with no restriction on the date of publishing. We found only 3 published case reports, all of which are of young patients presenting with visual complaints who were found to have very high BP readings (Table 1 ) [ 1 , 3 , 5 , 6 ]. All cases had features typical of hypertensive retinopathy as well as large areas of retinal ischemia and neovascularization with leakage.…”

“…She received a single intravitreal anti-VEGF injection and 1 session of PRP in each eye. She was then lost to follow-up and showed up many months later complaining of pain due to neovascular glaucoma [ 6 ]. She was not compliant with renal dialysis or with her antihypertensive medications.…”

Hipertensão maligna em paciente com nefropatia por imunoglobulina a (NIgA)

“…Um estudo relata que existe uma forte associação entre a gravidade da retinopatia hipertensiva e o nível da função renal, e que os pacientes com NIgA apresentam maior risco de complicações retino-coroidianas. As sequelas devastadoras da hipertensão não controlada podem ser potencialmente evitadas com o controle da pressão arterial 25 .…”

Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report

“…13 IgA deposits and inflammation can also occur systemically, especially in the intestines and ocular tissues. 3,[14][15][16][17][18][19] The most common ocular findings in patients with IgA nephropathy are inflammatory, including episcleritis, 15,16 keratoconjunctivitis, anterior uveitis, [20][21][22] nodular scleritis, 23 panuveitis, 24 retinal vasculitis, 25 serous retinal detachment, 14,25 uveal effusion syndrome, 26 and Vogt-Koyanagi-Harada disease. 27,28 Our case postulates a connection between chronic kidney disease secondary to IgA nephropathy and increased ICP.…”