Abstract：Objective: To observe the image characteristics of the macular area in patients with grade Ⅲ hypertensive retinopathy (HRP) using optical coherence tomography (OCT) and angiography (OCTA). Methods: This was a case series study. Seventy-nine patients (129 eyes) with grade Ⅲ (KWB) HRP were examined and analyzed by fundus photography, OCT and OCTA from May 2018 to May 2020 in the First Affiliated Hospital of Wenzhou Medical University. Morphological characteristics of macular OCT and OCTA were analyzed. The abnormality rate of OCT and OCTA was analyzed by χ2 text. Results: Twenty-nine patients had grade ⅢHRP changes in one eye (all the contralateral eyes had grade Ⅱ HRP changes), and 50 patients had grade Ⅲ HRP changes in both eyes among the 79 patients with grade Ⅲ HRP. Abnormal lesions were found in 48 eyes (37%) by OCT and in 93 eyes (72%) by OCTA among the 129 eyes with grade Ⅲ HRP. The sensitivity of abnormal lesions was higher with OCTA than with OCT (χ2 =28.04, P<0.001). The abnormal image features of OCT in the macula were as follows: The reflection from the outer plexiform layer of the retina was uneven, local thinning and elevation (35 eyes, 27%), scattered strong reflective light spots between the neuroepithelial layers (30 eyes, 23%), local strong reflection masses within the neuroepithelial layer (18 eyes, 14%), thinning of the inner layer of the neuroepithelial layer (18 eyes, 14%), local serous uplift in the neuroepithelial layer (11 eyes, 9%), diffuse edema and thickening in the neuroepithelial layer (6 eyes, 5%). The main abnormal image features of the macula in OCTA were local destruction and enlargement of the arch ring (66 eyes, 51%), sparsely scattered capillary foci (43 eyes, 33%), scattered microangioma (27 eyes, 21%), and focal capillary nonperfusion (9 eyes, 7%) at the levels of the superficial and deep vascular networks. Scattered strips of strong reflexive foci (12 eyes, 9%) were at the level of the deep vascular networks. The lesions at the levels of the deep vascular networks were more serious than those at the level of the superficial vascular network. Conclusions: Timely OCT combined with OCTA can evaluate the macular structure and blood flow imaging characteristics early in HRP patients, and OCTA is more intuitive and sensitive to retinal microvascular abnormalities. These findings can help to better understand the pathophysiological mechanisms of HRP and guide effective follow-up and treatment strategies
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