Synergistic Effects of Diabetic and Hypertensive Retinopathy in a Middle-Aged Patient: Case Report

Background: Diabetes mellitus (DM) and hypertension (HTN) are key drivers of microvascular retinal damage. Coexisting diabetic retinopathy (DR) and hypertensive retinopathy (HR) synergistically exacerbate retinal pathology, increasing the risk of irreversible vision loss. This Case Report details the management of severe proliferative diabetic retinopathy (PDR) and high-grade hypertensive retinopathy. 

Methods: A 55-year-old male with a 12-year history of poorly controlled type 2 DM (HbA1c 9.1%) and chronic HTN (≈170/100 mmHg) presented with progressive bilateral vision loss. Managed at Dr. Jawahar Lal Rohtagi Memorial Eye Hospital, Kanpur, from 2018 to 2025, his ophthalmic evaluation showed best-corrected visual acuity of 6/18 OD and 6/24 OS. Dilated fundus examination, fundus photography, and fluorescein angiography confirmed active PDR with high-risk neovascularization and Grade III hypertensive retinopathy, characterized by severe arteriolar narrowing, arterio-venous nicking, haemorrhages, and cotton-wool spots. Spectral-domain optical coherence tomography verified centre-involving diabetic macular oedema (DME) with elevated central retinal thickness.

Results: A multidisciplinary approach was employed, including intensified insulin therapy for glycaemic control, an optimized antihypertensive regimen (ACE inhibitor, calcium channel blocker, diuretic), and ocular interventions. Pan-retinal photocoagulation addressed PDR, while intravitreal ranibizumab injections treated DME. Over 7 years, stabilization of proliferative changes, reduction of DME and systemic improvements preserved functional vision.

Conclusion: Coexisting PDR and HR require urgent, coordinated intervention. Evidence-based ocular therapies (anti-VEGF, PRP) and rigorous systemic control of glycaemia and blood pressure are critical for vision preservation and mitigating vascular risks.