Bilateral Hypertensive Papillopathy with Diffuse Retinal Telangiectasis

Abstract

A 16-year-old type 1 diabetic female patient was consulted to our clinic for acute bilateral painless vision loss with a 2-week history in the right eye and a 1-week history in the left eye. At the initial visit, the best-corrected visual acuity was 0.2 in the right eye and 0.05 in the left eye. In fundus examination, both optic disks were pale and slightly swollen. In both eyes, superficial telangiectatic vessels were extending from the optic disk to the retina. Telangiectatic vessels disappeared within 10 days with systemic hypertension regulation and without any ocular treatment.

Keywords: Hypertensive papillopathy; optic disk; telangiectasic vessels.

Figure 1

Images were taken at the initial visit (BCVA was 0.2 in the right eye and 0.05 in the left eye) (a) Color fundus photograph of the right eye. The optic disk is pale and slightly swollen. There are telangiectatic vessels and splinter hemorrhages in the lower part of the optic disk. (b) Color fundus photograph of the left eye. The optic disk is swollen and superficial telangiectatic vessels and splinter hemorrhages are extending from the optic disk to the peripapillary retina. (c) Optical coherence tomography (OCT) imaging of the right eye. The macula is normal. (d) OCT imaging of the left eye. There is intraretinal and subretinal fluid.

Figure 2

Fundus fluorescein angiography (FFA) images at the initial visit. (a) FFA image of the right eye shows hyperfluorescence at the optic disk and inferior retina. There are several microaneurysms in the posterior pole. (b) There are telangiectatic vessels in the upper retina of the right eye. (c) FFA image of the left eye shows hyperfluorescence at the optic disk. There are telangiectatic vessels in the nasal retina. (d) FFA image of the left eye shows hyperfluorescence at the optic disk. There are several microaneurysms in the posterior pole.

Figure 3

Humphrey’s central 30–2 visual field images of both eyes at the initial visit. (a, b) There are peripheral visual field defects in both eyes.

Figure 4

Fundus fluorescein angiography (FFA) images at 6^th month. (a) There are several microaneurysms in the posterior pole of the right eye. (b) Telangiectatic vessels in the upper retina have disappeared. Ischemia and several microaneurysms are seen in the upper retina. (c) Telangiectatic vessels in the nasal retina have disappeared. (d) There are several microaneurysms in the posterior pole of the left eye.

Figure 5

Images were taken in the 6^th month (BCVA was 20/40 in the right eye and 20/63 in the left eye) (a, b) color fundus photograph of the right and left eye. All telangiectatic vessels and splinter hemorrhages have disappeared. (c, d) OCT imaging of the right and left eye is normal.