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Photo Essay
October 2003

Macular Hole and Macular Detachment in Severe Hypertensive Retinochoroidopathy

Arch Ophthalmol. 2003;121(10):1504-1505. doi:10.1001/archopht.121.10.1504

A 23-YEAR-OLD man with recently diagnosed malignant hypertension sought treatment because of 1 week of decreased vision in his left eye. He had no history of trauma. His blood pressure was 240/120 mmHg.

At examination, best-corrected visual acuity was 20/50 OD and 20/400 OS. Anterior segment examination results were unremarkable in both eyes. There was a minor vitreous hemorrhage in the left eye. Ophthalmoscopic examination showed narrowing of retinal arterioles, retinal hemorrhages, cotton-wool spots, and swollen discs in both eyes. In the left eye, there was a full-thickness 1500-µm operculated macular hole associated with a large macular detachment(Figure 1A). Fluorescein angiography demonstrated patchy areas of leakage with diffuse mottling of the retinal pigment epithelium and optic disc staining in both eyes. Dye pooled in the area of macular detachment, and there was mild hyperfluorescence of the macular hole (Figure 1B).

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