It is the principal purpose of this report to describe the retinal changes observed in lll severely hypertensive patients after total or subtotal adrenalectomy combined with the Adson or the Smithwick type of sympathectomy.1 Although improvement in the retinopathy of hypertension has been noted following various forms of medical and surgical therapy, the above-mentioned combined operations constitute a new approach to the treatment of essential hypertension and make available for study another group of patients. A secondary purpose of this report is to determine whether or not the ocular fundi can yield information that will be valuable in the selection of patients for whom such surgery can be beneficial.
Patients with severe hypertension show marked increase in peripheral vascular resistance and acceleration of arterial changes leading to impaired function and structural damage in such areas as the cerebrum, kidneys, heart, and retina. Moderate reduction in blood pressure can result