A congenital bladder diverticulum (CBD) is caused by inherent muscular weakness instead of obstruction of the bladder outlet. The major clinical conditions are recurrent urinary tract infection (UTI) and voiding dysfunction. This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. After the non-functioning right kidney and ureter and the bilateral diverticula were removed, the left ureter was reimplanted in the bladder. Pathologic findings showed chronic pyelonephritis and partial loss of the bladder musculature in the diverticular wall. This observation indicates that dilated CBD can cause latent UTI, ureteral obstruction, hydronephrosis, and secondary hypertension.
Adolescent ; Diverticulum ; Humans ; Hydronephrosis ; Hypertension ; Hypertension, Renal ; Hypertensive Retinopathy ; Kidney ; Muscle Weakness ; Pyelonephritis ; Ureter ; Ureteral Obstruction ; Urinary Bladder ; Urinary Tract Infections

PURPOSE: To report clinical features of patients with retinal and choroidal diseases presenting with acute visual disturbance during pregnancy. METHODS: In this retrospective case series, patients who developed acute visual loss during pregnancy (including puerperium) and visited a tertiary hospital from July 2007 to June 2015, were recruited by searching electronic medical records. Patients were categorized according to the cause of visual loss. Clinical features and required diagnostic modalities were analyzed in the retinal and choroidal disease group. RESULTS: Acute visual loss occurred in 147 patients; 49 (38.9%) were classified into the retinal and choroidal group. The diagnoses included central serous chorioretinopathy (22.4%), hypertensive retinopathy with or without pre-eclampsia (22.4%), retinal tear with or without retinal detachment (18.4%), diabetic retinopathy progression (10.2%), Vogt-Koyanagi-Harada disease (4.1%), retinal artery occlusion (4.1%), multiple evanescent white dot syndrome (4.1%), and others (14.3%). Visual symptoms first appeared at gestational age 25.9 ± 10.3 weeks. The initial best-corrected visual acuity (BCVA) was 0.27 ± 0.39 logarithm of the minimum angle of resolution (logMAR); the final BCVA after delivery improved to 0.13 ± 0.35 logMAR. Serious visual deterioration (BCVA worth than 20 / 200) developed in two patients. Differential diagnoses were established with characteristic fundus and spectral-domain optical coherence tomography findings in all cases. CONCLUSIONS: In pregnant women with acute visual loss, retinal and choroidal diseases are common and could be vision threatening. Physicians should be aware of pregnancy-associated retinal and choroidal diseases and their clinical features. The differential diagnosis can be established with non-invasive techniques.
Central Serous Chorioretinopathy ; Choroid Diseases* ; Choroid* ; Diabetic Retinopathy ; Diagnosis ; Diagnosis, Differential ; Electronic Health Records ; Female ; Gestational Age ; Humans ; Hypertensive Retinopathy ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Retinal Artery Occlusion ; Retinal Detachment ; Retinal Diseases ; Retinal Perforations ; Retinaldehyde* ; Retrospective Studies ; Tertiary Care Centers ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome ; Visual Acuity

Systemic hypertension affects not only the heart, kidneys, brain, and large arteries but also the eyes. High blood pressure (BP) causes a series of pathophysiological changes in the retinal vasculature, including focal and diffuse narrowing of the retinal arteriole, opacification of the arteriolar wall, and compression of the venules by arterioles. In severe cases, hemorrhage, nerve fiber layer infraction, and disc swelling can occur. Systemic hypertension results in various retinal vascular diseases, such as hypertensive retinopathy, retinal vein or artery occlusion, retinal arterial macroaneurysm, and nonarteritic ischemic optic neuropathy. High BP also increases the risk of development and progression of diabetic retinopathy. Signs of hypertensive retinopathy are predictive of target-organ damages, including cardiovascular and cerebrovascular diseases. While managing patients with hypertensive retinopathy, physicians should be aware of the management of cardiovascular and cerebrovascular risk factors.
Arteries ; Arterioles ; Brain ; Cardiovascular Diseases ; Cerebrovascular Disorders ; Diabetic Retinopathy ; Heart* ; Hemorrhage ; Humans ; Hypertension* ; Hypertensive Retinopathy ; Kidney ; Nerve Fibers ; Optic Neuropathy, Ischemic ; Retinal Vein ; Retinaldehyde ; Risk Factors ; Vascular Diseases ; Venules

PURPOSE: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. METHODS: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. RESULTS: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 +/- 66.55 microm (mean +/- SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 +/- 59.08 microm (mean +/- SD) (p = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (p = 0.002), and the mean change was 17.21 +/- 7.56. CONCLUSIONS: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness.
Blood Pressure ; Choroid* ; Humans ; Hypertension, Malignant* ; Hypertensive Retinopathy ; Intraocular Pressure ; Tomography, Optical Coherence

The most common etiology of spontaneous, non-traumatic intracerebral hemorrhage is hypertension. One of the most decisive factors for the determination of etiology is location of the hemorrhage. Here, we report on a 53-year-old female patient who was admitted with left putaminal hemorrhage. She did not have prominent vascular risk factors other than fundoscopic signs of hypertensive retinopathy. Magnetic resonance imaging and angiography revealed arteriovenous malformation (AVM) in the basal ganglia, which was fed by the lateral lenticulostriate artery. This case suggests that we should consider an AVM-related hemorrhage in relatively young stroke patients, regardless of hematoma location or presence of accompanying hypertension.
Angiography ; Arteries ; Arteriovenous Malformations ; Basal Ganglia ; Cerebral Hemorrhage ; Female ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Hypertensive Retinopathy ; Magnetic Resonance Imaging ; Middle Aged ; Putaminal Hemorrhage ; Risk Factors ; Stroke

PURPOSE: To report the relationship between hypertensive retinopathy and associated target organ damage in Korean hypertensive patients. METHODS: A total of 519 hypertensive patients were divided into hypertension retinopathy grades I through IV based on fundus examination. According to the grade of each hypertensive retinopathy, the frequency of target organ damage (cardiovascular disease, chronic kidney disease, and retinal vessel occlusion) and the association with hypertension retinopathy were evaluated. RESULTS: There were 211 patients (40.7%) without hypertensive retinopathy, 226 patients (43.5%) with hypertensive retinopathy grade I, 71 patients (13.7%) with grade II, seven patients (1.3%) with grade III and four patients (0.8%) with grade IV. The numbers of patients with cardiovascular disease were 103 (45.6%) in grade I, 57 (80.3%) in grade II, 3 (42.9%) in grade III, two (50.0%) in grade IV, and 70 (37.4%) in the non-hypertensive retinopathy group. According to four grades, the numbers of patients with cerebrovascular disease were three (1.3%), two (2.8%), zero (0%), and one (25.0%), respectively, with two (0.9%) in the non-hypertensive retinopathy patients. The respective numbers of patients with chronic kidney according to grades I through IV were 14 (6.2%), ten (14.0%), two (28.6%), and four (100.0%), as well as ten (4.7%) in the non-hypertensive retinopathy patients. The respective numbers of patients with retinal vessel occlusion were one (0.4%), two (2.8%), one (14.3%), and one (25.0%), with zero (0%) in the non-hypertensive retinopathy patients. CONCLUSIONS: The significance of hypertensive retinopathy should not be overlooked in Korean hypertensive patients due to an association with various target organ damage.
Cardiovascular Diseases ; Glycosaminoglycans ; Humans ; Hypertension ; Hypertensive Retinopathy ; Kidney ; Renal Insufficiency, Chronic ; Retinal Vessels

OBJECTIVE:To determine the current leading causes of new patient consults at the out-patient general clinic of the Department of Ophthalmology and Visual Sciences (DOVS), Sentro Oftalmologico Jose Rizal (SOJR).
METHODS: The data were gathered from the DOVS out-patient general clinic monthly census. Compilation and tabulation of the diagnoses of all new patients from January to December 2009 were done.
RESULTS: The leading causes of new patient consults were cataract (30.8%), error of refraction (20.1%), pterygium (6.1%), conjunctivitis (4.9%), dysfunctional tear syndrome (4.5%), glaucoma (4.3%), diabetic retinopathy (3.7%), and hypertensive retinopathy (3.4%).
CONCLUSION: Cataract and error of refraction comprise the majority of all causes of consultation among new patients.

Human ; Cataract ; Censuses ; Conjunctivitis ; Diabetic Retinopathy ; Glaucoma ; Hypertensive Retinopathy ; Ophthalmology ; Outpatients ; Pterygium ; Referral And Consultation ; Vision Tests

PURPOSE: To investigate the clinical characteristics of retinopathy associated with systemic lupus erythematosus (SLE) and its risk factors. METHODS: Medical records of patients who were diagnosed with SLE were reviewed retrospectively. The presence of retinal hemorrhage, vasculitis and a cotton wool patch were regarded as lupus retinopathy, but concomitant diabetic retinopathy and hypertensive retinopathy were excluded from the study. The correlation between the development of lupus retinopathy and the presence of positive autoantibodies was also investigated. RESULTS: Ocular morbidity was found in 173 of 260 (66%) SLE patients. Retinopathy was detected in 52 eyes of 33 patients (12%), which included 36 eyes of 21 patients (63%) with classic retinopathy and 11 eyes of 10 patients (30%) with vaso-occlusive retinopathy. The presence of classic retinopathy coincided with the flare-up of lupus activity and completely resolved without visual impairment. However, vaso-occlusive retinopathy was not related with lupus activity, and resulted in significant visual impairments of 20/200 or less in six eyes of five patients. The disease activity of lupus assessed by the maximum SLE disease activity index was higher in patients with retinopathy (p<0.05), and the prevalence of antiphospholipid antibody was higher in patients with vaso-occlusive retinopathy than in patients with classic retinopathy (66.7% vs. 37.5%, p<0.05). CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. Patients with high SLE activity or positive anti-phospholipid antibodies have a high possibility of developing SLE retinopathy and should be referred for ophthalmologic examination.
Antibodies ; Antibodies, Antiphospholipid ; Autoantibodies ; Diabetic Retinopathy ; Eye ; Humans ; Hypertensive Retinopathy ; Lupus Erythematosus, Systemic ; Medical Records ; Prevalence ; Retinal Hemorrhage ; Retrospective Studies ; Risk Factors ; Vasculitis ; Vision Disorders ; Wool

PURPOSE: To investigate the clinical characteristics of retinopathy associated with systemic lupus erythematosus (SLE) and its risk factors. METHODS: Medical records of patients who were diagnosed with SLE were reviewed retrospectively. The presence of retinal hemorrhage, vasculitis and a cotton wool patch were regarded as lupus retinopathy, but concomitant diabetic retinopathy and hypertensive retinopathy were excluded from the study. The correlation between the development of lupus retinopathy and the presence of positive autoantibodies was also investigated. RESULTS: Ocular morbidity was found in 173 of 260 (66%) SLE patients. Retinopathy was detected in 52 eyes of 33 patients (12%), which included 36 eyes of 21 patients (63%) with classic retinopathy and 11 eyes of 10 patients (30%) with vaso-occlusive retinopathy. The presence of classic retinopathy coincided with the flare-up of lupus activity and completely resolved without visual impairment. However, vaso-occlusive retinopathy was not related with lupus activity, and resulted in significant visual impairments of 20/200 or less in six eyes of five patients. The disease activity of lupus assessed by the maximum SLE disease activity index was higher in patients with retinopathy (p<0.05), and the prevalence of antiphospholipid antibody was higher in patients with vaso-occlusive retinopathy than in patients with classic retinopathy (66.7% vs. 37.5%, p<0.05). CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. Patients with high SLE activity or positive anti-phospholipid antibodies have a high possibility of developing SLE retinopathy and should be referred for ophthalmologic examination.
Antibodies ; Antibodies, Antiphospholipid ; Autoantibodies ; Diabetic Retinopathy ; Eye ; Humans ; Hypertensive Retinopathy ; Lupus Erythematosus, Systemic ; Medical Records ; Prevalence ; Retinal Hemorrhage ; Retrospective Studies ; Risk Factors ; Vasculitis ; Vision Disorders ; Wool

The renal manifestations of systemic sclerosis include proteinuria, hypertension, azotemia, and renal crisis. Two types of scleroderma renal crisis (SRC) are recognized. Typical SRC is a syndrome consisting of acute-onset malignant hypertension accompanied by rapidly progressive renal failure, hypertensive retinopathy, and elevated plasma renin activity. The other type is normotensive renal failure, which is generally accompanied by antineutrophil cytoplasmic autoantibody (ANCA)-positive crescentic glomerulonephritis. A 51-year-old woman with scleroderma without marked dermatological change developed ANCA-related renal failure. She had neither malignant hypertension nor an elevated plasma rennin concentration. Renal biopsy showed crescentic glomerulonephritis (pauci-immune type), and the myeloperoxidase-specific ANCA (MPO-ANCA) titer was elevated at 1015 AAU. She was cured using steroid pulse therapy, combined with an angiotensin-converting-enzyme inhibitor and angiotensin-II receptor blocker
Antibodies, Antineutrophil Cytoplasmic ; Azotemia ; Biopsy ; Chymosin ; Cytoplasm ; Female ; Glomerulonephritis ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertensive Retinopathy ; Isonipecotic Acids ; Middle Aged ; Plasma ; Proteinuria ; Renal Insufficiency ; Renin ; Scleroderma, Systemic