Hypertensive Proliferative Choriorretinopathy

Purpose: To report a case of hypertensive chorioretinopathy complicated by anterior segment neovascularization, refractory to PRP. Methods: Case Report and Literature Review. Results: A 57-year-old male with poorly controlled systemic hypertension (exceeding 200/100 mmHg) experienced progressive visual acuity loss in the left eye over two years, with worsening in the last six months. Slit-Lamp examination revealed neovascularization of the angle in the left eye. Fundoscopy disclosed pale choroidal vessels temporal to the macula of both eyes, as well as additional retinochoroidal findings, such as telangiectatic vessels and a rounded shaped pale subretinal region on the right eye and combined vascular occlusion in the left inferior hemi-retina. Fluorescein and indocyanine angiography showed delayed choroidal perfusion and marked retinal ischemia, consistent with severe Hypertensive Chorioretinopathy. Initial treatment with monthly intravitreal anti-VEGF injections and PRP led to remission of anterior segment neovascularization, but recurrence occurred after two months, requiring additional anti-VEGF therapy. Conclusion: The insufficient response to PRP in this case suggests that choroidal ischaemia may not be as amenable to laser treatment as ischaemic retina. Highlighting the importance of regular follow-up, this report underscores the need for comprehensive hypertensive control to prevent vision-threatening outcomes.