Pseudo-Glaucoma after Hypertensive Retinopathy

A 35-year-old Japanese woman showed the typical fundus appearance of acute hypertensive retinopathy, including multiple cotton-wool spots, retinal hemorrhages, star exudates, and disc edema bilaterally. Her systemic blood pressure was high (246/158 mmHg). Nephrologists diagnosed her with secondary hypertension due to immunoglobulin A nephropathy. After 2 years, all signs of acute retinopathy resolved and only multiple striated or sectorial darkening of the fundus (retinal nerve fiber layer defects [NFLD]) remained. Computerized analysis of the macular thickness measurement by optical coherence tomography alerted the risk of glaucoma. NFLD is a hallmark of early glaucoma that is more reliable than IOP elevations since normal tension glaucoma is popular in Japan. To differentiate this case from true glaucoma, information regarding her past history is critical for her future ophthalmologists.