Ophthalmic manifestations of L & rsquo; s & HTA and rsquo; arteriosclerosis

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I- Overview :

HTA >140/90 mm Hg

All the vascular system undergoes its consequences.

1 Billion & rsquo; individuals worldwide

  • extremely common condition
  • (25-30)% adult population in industrialized countries .
  • (60-70)% after 65 years

Mortality ++ (6% deaths in the World)

II- Reminders anatomical and physiological :

  • The retinal vasculature is twofold:

ACR :

  • inner retinal layers
  • The ACI opht ACR → → → BR (sup + inf) BR → ( temp+nasal )
  • The retinal vessels are terminal arterioles without possibility of substitution.
  • Includes Capillary retro: Endoth + Mb.b + Média + adventis ( United / waterproof jct ° nonwindowed)
  • At the intersection → AV, l & rsquo; artery and vein are included in the same sleeve & rsquo; weed .
  • No & rsquo; innervation (e + på) → local self-regulation

Choriocapillaire :

  • Retro ext layers + EP
  • Choroidal capillaries are formed by capill large diameter big way moléculesOfenêtrés
  • + innervation (e + Posting)

Bःhri (Bariérre blood-retinal)

Role important in understanding the pathophysiology of hypertensive retinopathy 2-PART:

Internal :

  • endothelial cells of the retinal vessels : Very tight barrier between plasma and retinal area

external :

  • EP (cellules st jointives)
  • Mb BREAK (permeable to large molecules)

III- pathophysiology :

local self-regulation :

is the & rsquo; Vx retinal specific ability to react to changes in TA VD) YOU ,TA↓, TA ↑ offset HR

• TA↑ : VC art active

• TA↑↑ : exceeded mechanism , HR internal décompenséeVBHR Out (edema, exsudat, haemorrhage..)

IV- Clinique :

1- Signes d’artériosclérose rétinienne :

  1. the reflection of the vascular wall changes
  2. Changes at the intersections arteriovenous

2- Signs of hypertensive retinopathy :

  1. arterial caliber Changes
  2. bleeding
  3. nodules
  4. dried exudates
  5. edema papillary

3- Choroïdopathie hypertensive :

  1. acute injury
  2. chronic lesions:

– Spots & rsquo; Elschnig
– Stries de SIEGRIST

The physiological arterial reflection :

the reflection of light at the convex surface of the column

Changes at the arteriovenous crossings is caused by fibrosis of the arteriolar wall which compresses the vein.

4- Signs of hypertensive retinopathy :

A- arterial caliber Changes :

The decreases arterial caliber can be diffuse and widespread, up up & rsquo; one third or one quarter of the normal caliber. They are sometimes located, segmentaires, with a beaded appearance or fusiform. They are particularly good views angiography denies art = 2/3 vein

B- bleeding :

Acceleration HTA process…. TRT urgent and close monitoring +++

Several types :

– superficial

Splinter perished papillary rupture BHR int…extravasation

– deep

round,punctuated, disseminated localized .ischémie (infarct)

C- cotton wool spots: nodules dvsoriques. exudates move

Their manifesto présenace severely impaired, localized, retinal perfusion. These are small superficial nodules, d & rsquo; first grayish, then brilliant white, with fuzzy edges,

D- dried exudates :

They appear as white spots or yellowish, limited well, located at the posterior pole, sitting behind the retinal vessels. Frequently, they take a provision in wheel radius centered on the fovea, constituting a macular star.

E- edema papillary :

In the early stage, only the & rsquo; slit lamp exam may detect : the disc is slightly raised relative to the retinal plane, the veins are dilated, absent spontaneous venous pulse.

IV- choroidopathy hypertensive :

L & rsquo; choroidal involvement is independent of & rsquo; retinal disease. It is found mainly in young patients who develop severe hypertension while their vessels are not flexible and sclerotic (toxémie gravidique, HTA d & rsquo; toxic origin).

On a 2 type lesions :

  1. acute injury
  2. chronic lesions(sequelae)

CLASSIFICATIONS :

1- Classification de KEITH-WAGNER-BARKER (1939) ++used

  • Stade 1 S. moderate retinal arterial narrowing
  • Stade 2 S. arteriosclerosis + marked : s.CAV and venous tortuosity
  • Stade 3 severe hypertension.
  • changing the general art class + haemorrhage
  • R et exudates
  • Pc vital short-term threat
  • Stade 4 HTA maligne
  • st 3 + ON
  • Pc vital extremely bad
  • Benefits : simple
  • disadvantages : Confusion of hypertension and arteriosclerosis stages no choroidopathy

2- Classification de kirkendall :

stadiums HTA Arteriosclerosis
• Stade 1 diffuse arterial narrowing Sign of the Cross
• Stade II exudate Narrowing
woolly arterial located
hemorrhage
• Stade III edema Préthrombose /
papillary vascular thrombosis
engainement arterial
Recho CREPE

V- Conclusion :

  • Must be distinguished : changes directly related to the & rsquo; elevation of blood pressure, reversible by treatment HTA. chronic changes, irreversible, related to the & rsquo; arteriosclerosis. The treatment is the treatment of & rsquo; hypertension.
  • HR remains a recognized event as that & rsquo; d & rsquo reached; a target organ in patients with hypertension.
  • It is important that & rsquo; appreciate the response of retinal vessels with anti-hypertension treatments because, if the pathology of these is reversible, it could indicate the reversibility of vascular changes in other organs (heart, rein, brain).

Dr Benlaribi's course – Faculty of Constantine

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