The fundus of the eye as a target organ in hypertension: a literature review

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Abstract

This review discusses the current understanding of hypertensive retinopathy. It describes the pathomorphology of hypertensive retinopathy according to its grade. The main approaches to classification and elements of pathophysiology are briefly considered, and the clinical significance of hypertensive changes in the fundus is examined. The characteristics of traditional and innovative methods of assessing the retina, and their accuracy in predicting the course of hypertension is discussed. Data from our investigations with scanning laser ophthalmoscopy and optical coherence tomographic angiography are presented. Our data show that uncomplicated hypertension in middle-aged men and women is accompanied by a distinct reduction in the diameter of the retinal arterioles and an expansion of the foveal avascular zone at the level of the superficial capillary plexus of the retina. We review the literature and present the results of our observations, demonstrating the retinoprotective benefits of antihypertensive therapy.

About the authors

Anton V. Barsukov

CardioClinic; Kirov Military Medical Academy

Author for correspondence.
Email: avbarsukov@yandex.ru
ORCID iD: 0000-0002-1943-9545
SPIN-code: 1516-0095

MD, D. Sci. (Med.), Prof., deputy head doctor

Russian Federation, Saint Petersburg; Saint Petersburg

Maria V. Yasenovets

Kirov Military Medical Academy

Email: eremeeva_m@bk.ru
ORCID iD: 0000-0002-1307-6261
SPIN-code: 7705-5756

сardiologist

Russian Federation, Saint Petersburg

Kseniya A. Shcherbakova

Kirov Military Medical Academy

Email: ksu2204@yandex.ru
ORCID iD: 0000-0001-8555-5192
SPIN-code: 9522-0155

MD, Cand. Sci. (Med.), сardiologist

Russian Federation, Saint Petersburg

Vladimir V. Iakovlev

Kirov Military Medical Academy

Email: yakovlev-mma@yandex.ru
ORCID iD: 0000-0001-5310-0812
SPIN-code: 9685-6072

MD, D. Sci. (Med.), assoc. prof., department’s senior lecturer

Russian Federation, Saint Petersburg

Boris A. Chumak

Kirov Military Medical Academy

Email: borchum07@yandex.ru
ORCID iD: 0000-0002-5010-7661
SPIN-code: 1973-6961

MD, Cand. Sci. (Med.), assoc. prof., interim head of department

Russian Federation, Saint Petersburg

Ekaterina V. Borisova

CardioClinic

Email: borisova-ev@kardioklinika.ru
ORCID iD: 0000-0002-0960-9627
SPIN-code: 1694-8120

MD, D. Sci. (Med.), head doctor

Russian Federation, Saint Petersburg

Dmitrii S. Maltsev

Kirov Military Medical Academy

Email: glaz.med@yandex.ru
ORCID iD: 0000-0001-6598-3982
SPIN-code: 4903-2333

MD, D. Sci. (Med.), head of unit of ophthalmology clinic

Russian Federation, Saint Petersburg

Maria A. Burnasheva

Kirov Military Medical Academy

Email: maria.andreevna1@gmail.com
ORCID iD: 0000-0001-7384-2223
SPIN-code: 5574-3595

MD, Cand. Sci. (Med.), ophthalmologist of ophthalmology clinic

Russian Federation, Saint Petersburg

Alexey N. Kulikov

Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993
SPIN-code: 6440-7706

MD, D. Sci. (Med.), Prof., head of ophthalmology clinic

Russian Federation, Saint Petersburg

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2. Fig. 1. Positive correlation of the R wave amplitude in lead aVL and the central venous retinal equivalent (fragment A), negative correlation of the left atrial volume index and the central arterial retinal equivalent (fragment B) in patients with uncomplicated hypertension (mean age 49.7±4.8 years). Note. ЛП – left atrium; ЦВЭС – central retinal venular equivalent;ЦАЭС – central retinal arteriolar equivalent. Source: Barsukov A.V. и et al., 2020 [37].

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3. Fig. 2. Data from scanning laser ophthalmoscopy in green light (fragments A, B), optical coherence tomography (fragments C, D),thermal map of the retina (fragments E, F), scanning laser ophthalmoscopy in infrared light (retro mode, fragment G) in female Z., 53 years old, with malignant hypertension (retinal examination performed in 2014). Note. Fragments А–Г show solid exudates (continuous arrow), fragments А and Б show “cotton” foci (dotted-dotted arrow), intraretinal hemorrhages (dash-dotted arrow); narrowed arterioles, dilated venules, arteriovenous ratio (AVS) 1:3 are also determined here; arteriovenous crossings of the 3rd stage. Fragments Д, Е show thickening of the retina due to swelling near the optic nerve head. In fragment Ж, the arrows indicate the zone of serous detachment of the retinal neuroepithelium (signs of central serous chorioretinopathy). Source: previously unpublished data.

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4. Fig. 3. Image of color photographic recording (fragments A, B), optical coherence tomography (fragments C, D), heat map of the retina (fragments D, F) in female Z, 61 years old, with controlled (previously malignant) hypertension (retinal examination performed in 2022). Note. Fragments А–Г do not show solid exudates; fragments A and B showno “cotton” foci and intraretinal hemorrhages; there is also a changein the diameter of the vessels: arteriovenous ratio (AVS) 1:2; arteriovenous crossings of the 1st stage. Fragments Д, Е show normalization of the thickness of the retina due to the disappearance of its edema near the optic nerve head. Source: previously unpublished data.

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Copyright (c) 2023 Barsukov A.V., Yasenovets M.V., Shcherbakova K.A., Iakovlev V.V., Chumak B.A., Borisova E.V., Maltsev D.S., Burnasheva M.A., Kulikov A.N.

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