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The n e w e ng l a n d j o u r na l of m e dic i n e images in clinical medicine Retinal Detachment in Malignant Hypertension A B C A 37-year-old woman with no previous medical conditions pre- Iqbal Tajunisah, F.R.C.S. sented with a 3-day history of headache and blurry vision. Her blood pres- Dinesh Kumar Patel, M.S. sure was elevated, at 220/150 mm Hg, and visual acuity in both eyes was (Ophthal.) such that she could count fingers only and had sluggish pupil reactivity. Retinal exUniversity of Malaya amination revealed bilateral disk swelling with scattered cotton-wool spots (Panel A, Kuala Lumpur 50603, Malaysia arrow) and bilateral inferior serous retinal detachment (Panel B, arrow). Further workup revealed that the patient had renal disease, with a serum creatinine level of 14.9 mg per deciliter (1320 µmol per liter). She was treated with isosorbide dinitrate and amlodipine in addition to undergoing hemodialysis. One week later, her blood pressure was 140/90 mm Hg and her visual acuity had improved to 20/80 bilaterally. Funduscopy, performed while the pupils were dilated, showed resolution of the serous retinal detachment and a reduced number of cotton-wool spots and hard exudates. Two weeks after treatment, her vision had further improved to 20/30 in both eyes, with complete resolution of the retinal changes (Panel C). The patient is currently undergoing follow-up for renal failure. Severe hypertension can lead to subretinal fluid accumulation and exudative retinal detachment, which is a medical emergency, because it can lead to blindness. Copyright © 2009 Massachusetts Medical Society. WEB-ONLY IMAGES IN CLINICAL MEDICINE Click on “Featured Images” at NEJM.org to see the Journal’s Web-only Images in Clinical Medicine. The Images are listed (with e page numbers) in the table of contents of the printed Journal the week they are published and are compiled at NEJM.org. n engl j med 361;9 nejm.org august 27, 2009 The New England Journal of Medicine Downloaded from nejm.org on August 19, 2012. For personal use only. No other uses without permission. Copyright © 2009 Massachusetts Medical Society. All rights reserved. 899