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Primary pulmonary arterial hypertension diagnosed via its ophthalmic features in an adult: diagnosis and therapeutic challenges
  1. Céline Faure1,
  2. Sophie Miocque1,
  3. Laurent Fleury2,
  4. Matthieu P Robert1
  1. 1Service d'Ophtalmologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033 Caen, France
  2. 2Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033 Caen, France
  1. Correspondence to Dr Céline Faure, Fondation Ophtalmologique Adolphe de Rothschild, 25–29, rue Manin, 75019 Paris, France; celinefaureb{at}yahoo.fr

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Case report

A 50-year-old man was referred to the ophthalmology emergency unit for visual loss of 5 days' duration. He had been emmetropic in the past and had been treated with prostaglandin drops for ocular hypertension in both eyes, but had stopped any specific follow-up and treatment many years previously. Past medical history was significant for angina pectoris, without any relevant family history. On examination, best-corrected visual acuity was right 20/200 with −2.25 DS, and left count fingers. Slit-lamp examination showed dilated episcleral veins bilaterally, which had been present since his twenties, according to the patient; in the right eye (RE) the minor arterial circle of the iris was dilated, and the angle was open, while rubeosis iridis and a hyphaema were observed in the left eye (LE) (figure 1). Intraocular pressure (IOP) was right 28 mm Hg and left 52 mm Hg. Fundus examination revealed a large neurosensory retinal detachment in the RE, but no view was possible in the LE. The patient was fatigued, cyanosed and dyspnoeic, with a pulse rate of 74 bpm and blood pressure of 120/80 mm Hg. Further history revealed constitutional symptoms over the last 2 years with a 20 kg weight loss. The haemoglobin level was 20.7 g/dl. Cardiac ultrasonography and right heart catheterisation were …

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