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• W2295238043 abstract "Background: The prospective study was done to study the fundus changes in 253 consecutive admissions of high altitude pulmonary oedema (HAPE), at a tertiary care service hospital located at 11,000 ft. Methods: All were males and majority were serving soldiers with age group ranging from 12 to 45 yrs. All were acclimatised before being inducted to various HA posts. The soldiers were diagnosed with HAPE and were evacuated from various posts to this service hospital. Their complete ocular examination was done and fundus was examined with direct ophthalmoscope. The fundus photographs were taken with a Nikon NFC 50 camera. None of these cases had an history of Diabetes Mellitus or Hypertension. Results: Incidence of abnormal fundi in HAPE cases were found to be 67% and these changes included venous engorgement with tortuocity, disc hyperaemia, papilloedema, retinal haemorrhages and neovascularisation. The incidence of retinal haemorrhages in HAPE was found to be 10.3%. Conclusion: Apart from incidence of fundus changes in HAPE, an attempt was made to correlate the findings with various factors. It was found that fundus changes as a whole and Retinal haemorrhage (RH) in particular showed a direct correlation with altitude and with clinical severity of the illness. Fresh inductees to HA were as prone to develop these changes as the reinductees. The fundus changes were usually transient and reverted back to normal prior to discharge from hospital. Introduction Travel to an altitude of 2500 mts or greater puts people at risk of developing HA illness. This could be in form of Acute mountain sickness (AMS), High altitude pulmonary oedema (HAPE), High altitude cerebral oedema (HACE) and Chronic mountain sickness (CMS). • AMS is generally milder and common form of HA illness. It is usually self-limiting and consists of a number of non-specific symptoms including headache, loss of appetite and nausea. • More severe forms of HA illness include HAPE and HACE and these may lead to coma and death if left untreated. • AMS and HACE are caused by hypoxia induced changes in blood-brain barrier leading to cerebral oedema and brain swelling. • In HAPE exaggerated pulmonary hypertension leads to increased vascular permeability. • AMS usually precedes development of HACE, whereas HAPE develops in first 2 to 4 days at HA and is not always preceded by AMS. • HAPE is probably the leading cause of death at HA. Humans are able to acclimatise to increasing altitude by: • Increasing ventilation (via carotid body hypoxic ventilatory response). • Increasing red blood cell production (via Erythropoietin). • Increasing vascularity of lung and tissues. • Suppression of AntiDiuretic Hormone (ADH) and Aldosterone and increasing tissue mitochondria. Materials and Methods: • Comprehensive ocular examination was done if patient’s condition permitted (same day or following day before pupillary dilatation). • Fundus was examined with direct ophthalmoscope. • Fundus was examined undilated on admission and following day after pupillary dilatation. • Retinal haemorrhage was followed till it was absorbed. • Fundus photograph was done by Nikon NFC50. • Cases with Diabetes Mellitus and Hypertension were excluded from this study. Results: 1.Fundus changes in HAPE was: 1.Venous engorgement with tortuocity 2.Disc hyperaemia 3.Papilloedema 4.Retinal haemorrhages and neovascularisation Out of 170 cases, fundus changes were seen as Venous engorgement (164 cases), disc hemorrhage (73 cases), retinal hemorrhage (28 cases), papilloedema (13 cases) and neovascularisation (1 case). 2.Out of the total cases examined, the breakdown was as follows: 253 – Fundus examined of HAPE 194 – Were acclimatised 23 Were smokers Were reinductees. 3.The severity of HAPE cases were of the following: Mild – 47.4% •" @default.
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• W2295238043 date "2016-03-01" @default.
• W2295238043 modified "2023-09-27" @default.
• W2295238043 title "Fundus Changes at High Altitude Pulmonary Oedema" @default.
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