Alireza Ramezani, Masoud Soheilian, Peyman Saberian, Homayon Kohi, Saied Alipoor Parsa, Shahbazi Mehdi Yaseri (Tehran, Iran)


Using fundus auto fluorescence as one of the manifestations as well as a possible alarming sign of macular damage in patients with chronic essential hypertension.


In a case control study, we evaluated 35 eyes of 35 patients with chronic essential hypertension (lasting more than 5 years) and 31 eyes of 31 volunteers without history of hypertension. After a cardiovascular examination, fundus auto fluorescence picture was taken from right eye of all cases with Heidelberg Retina Angiography and assessed by two-masked ophthalmologist.

Effectiveness / Safety:

Considering all auto fluorescence pictures, 3 apparently abnormal patterns were recognized. A ring of hyper-auto fluorescence in the central macula (doughnut shaped) was detected in 9 eyes (25.7%) of the hypertensive group but only in 2 eyes (6.5%) of the controls. This difference was statistically significant (P = 0.036). Hypo-auto fluorescence around disk was noticed in 11 (31.4%) eyes of the patients compared to 8 (25.8%) eyes of the controls (P = 0.615). The third feature, which was hypo- and/or hyper-auto fluorescence patches outside the fovea, was found more in the hypertensive group (8 eyes, 22.9%) than in the controls (2 eyes, 6.5%); however, this difference was not statistically significant (P = 0.089). Therefore, we may conclude that a ring of hyper-auto fluorescence in the central macula forming a doughnut shaped feature may be a fundus auto fluorescence sign in patients with chronic essential hypertension and can be considered as an alarming feature of so me macular damage in these patients.

Take home message:

Patients with chronic essential hypertension may represent a doughnut shaped feature in their fundus auto fluorescence images.