高血压英文ppt精品课件hypertensive

HYPERTENSIVE RETINOPATHY DR AJAY DUDANI DR YASHESH MANIAR - MANY CAUSES - MAINLY ESSENTIAL HYPERTENSION SYSTEMIC HYPERTENSION (JNCV 5TH) STATE OF PERSISTENT ELEVATED BLOOD PRESSURE ABOVE 140/90 mmHg. 5TH JOINT NATIONAL COMMITTEE CLASSIFICATION OF BLOOD PRESSURE CATEGORY SYSTOLIC BP DIASTOLIC BP (mmHg) (mmHg) NORMAL 210 120 PATHOPHYSIOLOGICAL CHANGES IN HYPERTENSIVE OCULAR DISEASE 1. HYPERTENSIVE CHOROIDOPATHY 2. HYPERTENSIVE RETINOPATHY 3. - VASOCONSTRICTIVE PHASE 4. - SCLEROTIC PHASE 5. - EXUDATIVE PHASE 6. - COMPLICATIONS OF THE SCLEROTIC PHASE 7. 3. HYPERTENSIVE OPTIC NEUROPATHY 8. - OPTIC DISC EDEMA 9. - OPTIC ATROPHY 10. - ISCHEMIC OPTIC NEUROPATHY OCULAR HYPERTENSION ARTERIOSCLEROSIS GRADE 0 NORMAL GRADE 1 INCREASED LIGHT REFLEX, WITH MILD ARTERIOVENOUS CROSSING DEFECTS GRADE 2 COPPER WIRE APPEARANCE GRADE 3 SILVER WIRE APPEARANCE, WITH MARKED ARTERIO VENOUS CROSSING DEFECTS GRADE 4 FIBROUS CORD Grading of arteriolosclerosis OCULAR HYPERTENSION ARTERIOLES A-V RATIO FOCAL SPASM GRADE 0 3:4 1:1 GRADE 1 1:2 1:1 GRADE 2 1:3 2:3 GRADE 3 1:4 1:3 +/- C W SPOT GRADE 4 FIBROUS CORD NO DISTAL FLOW +/-ELS SPOT HYPERTENSIVE RETINOPATHY HEMORRHAGE EXUDATE DISC EDEMA GRADE 0 - - - GRADE 1 - - - GRADE 2 - - - GRADE 3 + + - GRADE 4 + + + GRADE 1 HTR n GENERALIZED ARTERIOLAR ATTENUATION n BROADENING OF ARTERIOLAR LIGHT REFLEX n CONCEALMENT OF VEIN AT A-V CROSSINGS GRADE 2 HTR n SEVERE GENERALIZED AND FOCAL ARTERIOLAR CONSTRICTION n A-V CROSSING CHANGES (SALUS SIGN) GRADE 3 HTR n Copper wiring of arterioles n Venous banking distal to A-V crossing (bonnets sn) n Venous tapering on either side of crossing (gunns sn) n Right angle deflection of veins. n Flame shaped hemorrhages cotton wool spots, hard exudates. GRADE 4 HTR n All changes of grade 3 n Silver wiring of arterioles n Disc edema Ocular associations of hypertension Retinal vein occlusion CRVO (Central Retinal Vein Occlusion) HRVO (Hemi Retinal Vein Occlusion) BRVO (Branch Retinal Vein Occlusion) Constitutes 69.5 % of all RVO cases CRVO . Classic Appearance Mildest Form CRVO NON ISCHAEMIC ISCHAEMIC 62/F PR No 17474 CRVO IVTA (elsewhere) Baseline 20/500 3 weeks 20/500 3 months 20/200 62/F PR No 17474 CRVO (S/P IVTA) 2nd IVTA 5 months 20/400 8 months 20/100 Avasti n 2nd Avastin Hayreh et al n Non Ischaemic : Due to simple occlusion of retinal venous system n Ischaemic : Due to combined occlusion of the arterial & venous circulation Green et al Thrombus formation in the region of lamina cribrosa is the primary event CRVO Complications / Sequelae . q Macular oedema q Haemorrhage q Ischaemia stimulates neovascularization in n Optic disc n Retina n Angle n Iris - Rubeosis may cause Neovascular Glaucoma q Rhegmatogenous RD q Vascular complications n Microaneurysyms n Optociliary vessels collaterals between retinal & ciliary vessels CRVO Cilioretinal artery occlusion Combined with CRVO Cilioretinal artery occlusion Combined with anterior ischaemic optic neuropathy HRVO . HRVO . n Superior & Inferior vein do not merge into Central Vein before entering into lamina cribrosa n Like CRVO, only superior or inferior half involved n Types - 2/3rd : Venous stasis - 1/3rd : Haemorrhagic n Rest Rx or management same as CRVO BRVO . 45/M PR No 17422 BRVO Baseline 20/500 STT 3 weeks 20/500 Avastin 6 weeks/8 m 20/80 45/M PR No 17422 BRVO BRVO BRVO . nPortion of retina involved nMostly temporal - 62% Superotemporal - 38% Inferotemporal nNasal uncommon & asymptomatic nOccurs exclusively at arterial overcrossing at AV intersection by a thrombus Investigations in RVO . n Hb/CBC/ESR/Platelet count n BSL Fasting/PP n BP n Sr. Lipid Profile n IOP Measurement n FFA n ANA/Anti-ds DNA n VDRL/FTA-Abs n LE Cell In Young . n Protein C levels n Protein S levels n Platelet Analysis n Sr. & Urine for Homocysteine levels Others . n Hb Electrophoresis n PT / PTT n Anti-Phospholipid antibody n Complete Cardiovascular evaluation Traditional Rx Options . n To treat the associated systemic diseases (Medical Rx) n To treat the ocular complications (Laser or Sx) - CRVO Study Group - BRV