Pseudo-Glaucoma after Hypertensive Retinopathy

Katsunori Hara, Masaki Tanito, Yasurou Koyama, Akihiro Ohira

Department of Ophthalmolgy, Faculty of Medicine, Shimane University, Izumo, Japan..

DOI: 10.4236/ojoph.2013.32011                

Abstract

A 35-year-old Japanese woman showed the typical fundus appearance of acute hypertensive retinopathy, including multiple cotton-wool spots, retinal hemorrhages, star exudates, and disc edema bilaterally. Her systemic blood pressure was high (246/158 mmHg). Nephrologists diagnosed her with secondary hypertension due to immunoglobulin A nephropathy. After 2 years, all signs of acute retinopathy resolved and only multiple striated or sectorial darkening of the fundus (retinal nerve fiber layer defects [NFLD]) remained. Computerized analysis of the macular thickness measurement by optical coherence tomography alerted the risk of glaucoma. NFLD is a hallmark of early glaucoma that is more reliable than IOP elevations since normal tension glaucoma is popular in Japan. To differentiate this case from true glaucoma, information regarding her past history is critical for her future ophthalmologists.

Keywords

Hypertensive Retinopathy; Pseudo-Glaucoma; Retinal Nerve Fiber Layer Defects (NFLD); Spectral-Domain Optical Coherence Tomography (SD-OCT)

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Foster and S. Resnikoff, “The Impact of Vision 2020 on Global Blindness,” Eye (London, England), Vol. 19, No. 10, 2005, pp. 1133-1135. doi:10.1038/sj.eye.6701973
[2]	L. M. Alencar, F. A. Medeiros and R. Weinreb, “Progressive Localized Retinal Nerve Fiber Layer Loss Following a Retinal Cotton Wool Spot,” Seminars in Ophthalmology, Vol. 22, No. 2, 2007, pp. 103-104. doi:10.1080/08820530701420058
[3]	E. Chihara, T. Matsuoka, Y. Ogura and M. Matsumura, “Retinal Nerve Fiber Layer Defect as an Early Manifestation of Diabetic Retinopathy,” Ophthalmology, Vol. 100, No. 8, 1993, pp. 1147-1151.
[4]	K. Hara, M. Tanito and A. Ohira, “Retinal Nerve Fibre Layer Defects Associated with Cotton-Wool Spots in Patients with Interferon Retinopathy,” Acta Ophthalmologica, Vol. 90, No. 2, 2012, pp. e158-e160. doi:10.1111/j.1755-3768.2011.02106.x
[5]	J. W. Koh, K. H. Park, M. S. Kim and J. M. Kim, “Localized Retinal Nerve Fiber Layer Defects Associated with Cotton Wool Spots,” Japanese Journal of Ophthalmology, Vo. 54, No. 4, 2010, pp. 296-299. doi:10.1007/s10384-010-0830-0
[6]	A. Iwase, Y. Suzuki, M. Araie, T. Yamamoto, H. Abe, K. Shirato, Y. Kuwayama, H. K. Mishima, H. Shimizu, G. Tomita, Y. Inoue and Y. Kitazawa, “The Prevalence of Primary Open-Angle Glaucoma in Japanese: The Tajimi Study,” Ophthalmology, Vol. 111, No. 9, 2004, pp. 16411648.