高血压英文课件HYPERTENSIVE

HYPERTENSIVERETINOPATHY

DRAJAYDUDANIDRYASHESHMANIAR.HYPERTENSIVERETINOPATHY1--MANYCAUSES--MAINLYESSENTIALHYPERTENSION.--MANYCAUSES.2SYSTEMICHYPERTENSION(JNCV5TH)STATEOFPERSISTENTELEVATEDBLOODPRESSUREABOVE140/90mmHg..SYSTEMICHYPERTENSIONSTATEOF35THJOINTNATIONALCOMMITTEECLASSIFICATIONOFBLOODPRESSURECATEGORY SYSTOLICBP DIASTOLICBP (mmHg) (mmHg)NORMAL <130 <85HIGHNORMAL 130-139 85-89STAGE1(MILD) 140-159 90-99STAGE2(MOD.) 160-179 100-109STAGE3(SEVERE) 180-209 110-119STAGE4(V.SEVERE)>210 >120.5THJOINTNATIONALCOMMITTEEC4PATHOPHYSIOLOGICALCHANGESINHYPERTENSIVEOCULARDISEASEHYPERTENSIVECHOROIDOPATHYHYPERTENSIVERETINOPATHY --VASOCONSTRICTIVEPHASE --SCLEROTICPHASE --EXUDATIVEPHASE --COMPLICATIONSOFTHESCLEROTICPHASE3.HYPERTENSIVEOPTICNEUROPATHY --OPTICDISCEDEMA --OPTICATROPHY --ISCHEMICOPTICNEUROPATHY.PATHOPHYSIOLOGICALCHANGESIN5OCULARHYPERTENSIONARTERIOSCLEROSISGRADE0 NORMALGRADE1 INCREASEDLIGHTREFLEX, WITHMILDARTERIOVENOUS CROSSINGDEFECTSGRADE2 COPPERWIREAPPEARANCEGRADE3 SILVERWIREAPPEARANCE, WITHMARKEDARTERIO VENOUSCROSSINGDEFECTSGRADE4 FIBROUSCORD.OCULARHYPERTENSIONARTERIOS6Gradingofarteriolosclerosis.Gradingofarteriolosclerosis.7OCULARHYPERTENSIONARTERIOLES

A-VRATIO FOCALSPASMGRADE0 3:4 1:1GRADE1 1:2 1:1GRADE2 1:3 2:3GRADE3 1:4 1:3+/-CWSPOTGRADE4 FIBROUSCORD NODISTALFLOW+/-ELSSPOT.OCULARHYPERTENSIONARTERIOLES 8HYPERTENSIVERETINOPATHY

HEMORRHAGE EXUDATE DISCEDEMA

GRADE0 - - -GRADE1 - - -GRADE2 - - -GRADE3 + + -GRADE4 + + +.HYPERTENSIVERETINOPATHY HEMO9GRADE1HTRGENERALIZEDARTERIOLARATTENUATIONBROADENINGOFARTERIOLARLIGHTREFLEXCONCEALMENTOFVEINATA-VCROSSINGS.GRADE1HTRGENERALIZEDARTERIO10GRADE2HTRSEVEREGENERALIZEDANDFOCALARTERIOLARCONSTRICTIONA-VCROSSINGCHANGES(SALUSSIGN).GRADE2HTRSEVEREGENERALIZED11GRADE3HTRCopperwiringofarteriolesVenousbankingdistaltoA-Vcrossing(bonnet’ssn)Venoustaperingoneithersideofcrossing(gunn’ssn)Rightangledeflectionofveins.Flameshapedhemorrhagescottonwoolspots,hardexudates..GRADE3HTRCopperwiringofar12GRADE4HTRAllchangesofgrade3SilverwiringofarteriolesDiscedema.GRADE4HTRAllchangesofgrad13Ocularassociationsofhypertension

Retinalveinocclusion

CRVO(CentralRetinalVeinOcclusion)HRVO(HemiRetinalVeinOcclusion)BRVO(BranchRetinalVeinOcclusion) Constitutes69.5%ofallRVOcases.Ocularassociationsofhyperte14CRVO...

ClassicAppearance

MildestForm.CRVO...ClassicAppearanceMi15CRVONONISCHAEMICISCHAEMIC.CRVONONISCHAEMICISCHAEMIC.1662/FPRNo17474CRVO

IVTA(elsewhere).62/FPRNo1747417Baseline20/5003weeks20/5003months20/20062/FPRNo17474CRVO(S/PIVTA)2ndIVTA5months20/4008months20/100Avastin2ndAvastin.Baseline18Hayrehetal–Non–Ischaemic:DuetosimpleocclusionofretinalvenoussystemIschaemic:Duetocombinedocclusion ofthearterial&venouscirculationGreenetal– Thrombusformationintheregionoflaminacribrosaistheprimaryevent

CRVO.Hayrehetal–CRVO.19Complications/Sequelae...MacularoedemaHaemorrhageIschaemiastimulatesneovascularizationin

OpticdiscRetinaAngleIris-RubeosismaycauseNeovascularGlaucomaRhegmatogenousRDVascularcomplicationsMicroaneurysymsOptociliaryvessels–collateralsbetweenretinal&ciliaryvesselsCRVO.Complications/Sequelae...Ma20CilioretinalarteryocclusionCombinedwithCRVO.CilioretinalarteryocclusionC21CilioretinalarteryocclusionCombinedwithanteriorischaemicopticneuropathy.CilioretinalarteryocclusionC22HRVO....HRVO....23HRVO...Superior&InferiorveindonotmergeintoCentralVeinbeforeenteringintolaminacribrosaLikeCRVO,onlysuperiororinferiorhalfinvolvedTypes 2/3rd : Venousstasis1/3rd : HaemorrhagicRestRxormanagementsameasCRVO.HRVO...Superior&Inferiorve24BRVO....BRVO....2545/MPRNo17422BRVO.45/MPRNo17422BRVO.26Baseline20/500STT3weeks20/500Avastin6weeks/8m20/8045/MPRNo17422BRVO.Baseline20/500STT3w27BRVO.BRVO.28BRVO...PortionofretinainvolvedMostlytemporal-62%Superotemporal38%InferotemporalNasal–uncommon&asymptomaticOccursexclusivelyatarterialovercrossingatAVintersectionbyathrombus.BRVO...Portionofretinainvo29InvestigationsinRVO...Hb/CBC/ESR/PlateletcountBSL–Fasting/PPBPSr.LipidProfileIOPMeasurementFFAANA/Anti-dsDNAVDRL/FTA-AbsLECell.InvestigationsinRVO...Hb/CB30InYoung...ProteinClevelsProteinSlevelsPlateletAnalysisSr.&UrineforHomocysteinelevels.InYoung...ProteinClevels.31Others...HbElectrophoresisPT/PTTAnti-PhospholipidantibodyCompleteCardiovascularevaluation.Others....32TraditionalRxOptions...

Totreattheassociatedsystemicdiseases (MedicalRx)Totreattheocularcomplications (LaserorSx)

-CRVOStudyGroup -BRVOStudyGroup.TraditionalRxOptions...To33

Retinalarterymacroane