Hypertensive crisis with massive retinal and choroidal infar
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A 30-year-old female with no prior ophthalmic complaints presented with a 1-week history of bilateral gradual painless vision loss. Her blood pressure was 225/115 mm Hg. Past medical history included chronic renal failure from IgA nephropathy requiring hemodialysis for the past 8 years. She had a history of noncompliance with her dialysis which led to multiple hospital admissions, where she was found to be in hypertensive crisis but never reported visual complaints.Visual acuity was hand motion in the right eye and counting fingers in the left eye. Slit lamp examination was unremarkable in both eyes. Funduscopic examination revealed disc swelling, diffuse retinal hemorrhages, and sclerotic and attenuated vessels with sheathing in both eyes. Blood pressure normalized with hemodialysis and oral anti-hypertensives but visual acuity did not improve. She received one intravitreal injection of Bevacizumab and one session of pan-retinal photocoagulation in each eye but was lost to further follow up.

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