Ocular ischemic changes in thrombotic microangiopathy associated with malignant arterial hypertension (case study)

Abstract

The article presents a clinical observation of visual organ damage as an extrarenal manifestation of thrombotic microangiopathy in malignant arterial hypertension with an analysis of structural and functional changes in the eye by modern examination methods. The presence of renal thrombotic microangiopathy was verified by kidney biopsy. Optical coherence tomography was used to determine structural changes in the inner and outer layers of the retina in the form of their disorganization, areas of thickening of the nerve fiber layer, intraretinal inclusions and cysts, alterations of the ellipsoid zone and retinal pigment epithelium. Optical coherence tomography angiography revealed areas of vascular pattern attenuation in the deep and superficial retinal plexuses corresponding to OCT-detected foci of disorganization of the inner retinal layers. Color Doppler imaging showed absence of the diastolic component of the Doppler spectrum with an increase in the peripheral resistance index RI up to 1.0 in the central retinal artery and posterior short ciliary arteries in both eyes. Functional changes observed with multifocal electroretinography and microperimetry corresponded to the structural changes. Taking into account the similarity of microcirculation in the kidneys and the eyes, the probable pathogenetic mechanism underlying the detected structural and functional symptoms of ischemic damage to the visual organ in malignant arterial hypertension is chronic thrombotic microangiopathy. An interdisciplinary approach to studying thrombotic microangiopathy, including those associated with malignant arterial hypertension, using high-tech examination methods can be useful for timely diagnosis and treatment of this pathology.