Efficacy of Subtenonal Administration of Triamcinolone Acetate in a Patient with Malignant Hypertension–a Case Report

BACKGROUND: Malignant hypertension is a condition characterized by severe hypertension and multiorganic ischemic complications. The underlying cause of malignant hypertension can be primary or secondary hypertension, and identification of the cause is mandatory to select the correct treatment to control blood pressure and reduce end-organ damage. Hypertensive retinopathy is a disease that has short-term and long-term consequences for the overall health and mortality of patients. OBJECTIVE: The aim of this article is to present a case of malignant hypertension and hypertnive maculopathy detected in a female patient as well as the positive response that occurs after administration of only one ampoule of triamcinolone subtenonially in two doses in monthly intervals. CASE REPORT: A 50-year-old patient comes to our clinic for an ophthalmological consultation after noticing impaired vision back a few months, especially noticeable on her left eye. Examination of the fundus visualizes PNO of unclear boundaries, especially in the inferior quadrants, mottled hemorrhages localized around the neuroretinal rim, edematous macula with hard deposits in the form of stelatae primarily on the left eye, and cotton wool exudates on the retina on both sides, nevus chorioidee of the right eye. Blood vessels hypertonically altered. On the OCT images of the macula, neurosensory retinal ablations are observed on both sides, intraretinal fluid with intraretinal hard deposits is present, more pronounced on the left. The seriousness of the condition is explained to the patient, as well as that in this state it requires urgent hospitalization, therapy is prescribed in the form of carbonic anhydrase inhibitors to preserve the macula, and a treatment algorithm is arranged in the form of subtenonial application of triamcinolone after dehospitalization. At check-ups, there is a subjective and objective positive shift in the patient’s condition. CONCLUSION: The presence of hypertensive retinopathy may help to stratify the patient when assessing the future risk of stroke, coronary artery disease, and heart and kidney failure, even if the hypertension is well controlled.There is also a need to emphasize the obligatory symbiosis of internal medicine and ophthalmological disciplines, as well as to point out the fact that triamcinolone, as one of the very available and more affordable drugs, very effectively helps in the algorithm of treatment of these patients.