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Ayushi Gupta and Vishal Agrawal
This previously healthy 40YO female presented with 2 months of painless bilateral vision loss. She had occasional headaches, which she self-medicated with painkillers. Vision was counting fingers OD and 20/120 OS.
Color photography in her right eye shows a mildly swollen nerve, extensive hemorrhages in the nerve fiber layer, nerve fiber layer infarcts (cotton-wool spots), and a macular lipid star. OCT scanning shows outer retinal fluid with hyperreflective lipid flecks and foveal subretinal fluid. Similar findings are present in her left eye.
Her blood pressure in our office was 166/122 mmHg. She was immediately referred for emergent medical care.
Learning Points:
Malignant hypertension, defined as blood pressure above 180 systolic and/or 120 diastolic, is a life-threatening medical emergency. Eye doctors are in a unique position to often diagnose this condition. Patients will often present with bilateral optic nerve swelling, flame-shaped retinal hemorrhages, and, with more chronic disease, lipid precipitates in the nasal macular outer plexiform layer. Since the macular fluid emanates from the optic nerve, the macular lipid and thickening are virtually always worse nasally and are an important clinical clue for this diagnosis.
Int J Retina Vitreous. 2026 Jun 27;12(1):127. doi: 10.1186/s40942-026-00884-5.
PPV for myopic foveoschisis with foveal detachment: Air (vs no air) tamponade increased early anatomic recovery, but similar long-term anatomic and VA outcomes — Retrospective, 47 eyes
Purpose: To compare the efficacy of pars plana vitrectomy with or without air tamponade for patients with myopic foveoschisis (MFS) and foveal detachment (FD).
Methods: Forty-seven patients (47 eyes) with MFS and FD who underwent PPV with fovea-sparing internal limiting membrane peeling were included in this retrospective analysis. Patients were divided into air-tamponade (n = 21) and no-air-tamponade (n = 26) groups. Central foveal thickness (CFT), external limiting membrane (ELM) / ellipsoid zone (EZ) integrity, best-corrected visual acuity (BCVA), and incidence of complications were compared.
Results: In longitudinal analysis, the air-tamponade group had significantly faster CFT reduction at 1 week and 1 month (both P < 0.05). By 3 and 12 months, the CFT values were comparable between groups. Time to foveal reattachment was shorter with air tamponade (P < 0.001). The ELM and EZ integrity were compared at 12 months (both P > 0.05). Postoperative BCVA showed significant improvement from baseline at 3 and 12 months in both groups (P < 0.05). The time-by- tamponade type interaction at 3 and 12 months was not significantly different on BCVA in multivariable model (P > 0.05). Baseline diameter of FD was identified as an independent risk factor of 12-month BCVA by multivariable analysis. Complication rates, including postoperative macular hole, macular hole with retinal detachment, and transient aggravation, did not significantly differ between groups.
Conclusion: Air tamponade accelerated early anatomical recovery in MFS with FD, but both tamponade types achieved comparable long-term anatomical and visual outcomes. Baseline FD diameter was the independent predictor of visual outcome.
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