Do angiographic data support a detailed classification of hypertensive fundus changes?

The eye is a target organ as well as an established prognostic indicator of arterial hypertension. Based on the ophthalmoscopically visible alterations, several classifications, the majority of them grading hypertensive fundus changes into four stages, have been suggested. Moreover, assessment of hypertensive alterations of the perivoveal microcirculation has become possible by means of fluorescein angiography. However, it has not yet been evaluated whether an angiographic equivalent for the ophthalmoscopic classifications exists. We therefore compared the perifoveal microcirculation of hypertensive patients who were staged according to the classification of Neubauer, a modification of the classification of Keith and Wagener, among each other and with that of normal subjects. According to Neubauer, who distinguishes between fundus hypertonicus (stages I-II) and hypertensive retinopathy (stages III-IV), we divided the patients (n = 143) into four groups: stage I (n = 49), stage II (n = 72), stage III (n = 16), and stage IV (n = 6). All patients underwent fluorescein angiography performed with a scanning laser ophthalmoscope. By means of digital image analysis we quantified the following parameters: (1) perifoveal intercapillary area (PIA), (2) the area of the foveal avascular zone (FAZ), and (3) capillary blood velocity (CBV). All patients with arterial hypertension demonstrated a rarefaction of the perifoveal capillary bed and a decrease of capillary blood velocity as compared with normal subjects. Significant changes of PIA (P < 0.05) and CBV (P < 0.05) were seen between mild (I-II) and severe stages (III-IV) of hypertensive retinopathy, but neither between stages I and II nor between stages III and IV. Our findings indicate significant angiographic differences between mild and severe form of hypertensive retinopathy, however, unlike in ophthalmoscopy, a differentiated division into four stages is not possible.