Bilateral optic disc edema in patients with severe systemic arterial hypertension: Clinical features and visual acuity outcomes

BACKGROUND AND OBJECTIVE: To report clinical features and visual outcomes in patients with bilateral optic disc edema and severe systemic arterial hypertension. PATIENTS AND METHODS: Records were re viewed of patients with bilateral optic disc edema, severe arterial hypertension, and 3 or more months of follow-up evaluated at Bascom Palmer Eye Institute between 1982 and 2003. RESULTS: Sixteen patients (median age = 41 years; median follow-up = 31 months) were identified. Median blood pressure on initial eye examination was 220 mm Hg systolic and 126 mm Hg diastolic. Among all study eyes, median visual acuity was 20/55 on presentation. At the last follow-up examination, an acuity of 20/50 or better was achieved in 20 (63%) eyes; 12 (75%) patients achieved a final acuity of 20/50 or better in at least one eye. Posterior segment abnormalities at last follow-up included disc pallor (n = 16), macular star (n = 7), retinal pigment epithelial atrophy (n = 7), epiretinal membrane (n = 5), branch retinal vein occlusion (n = 4), and persistent disc edema (n = 2). Causes of final acuity of less than 20/50 included optic atrophy, epiretinal membrane, serous retinal detachment, macular hole, and branch retinal vein occlusion. CONCLUSION: Most patients with bilateral optic disc edema and severe arterial hypertension maintained visual acuity of 20/50 or better in at least one eye.