Copper wire arteries

The Keith-Wagener-Barker (KWB) classification for the assessment of hypertension-related changes in the ocular fundus vessels was first published by the same authors in 1939 (Aissopou 2015).

In 2004, Mitchell and Wong introduced a simplified three-stage classification in which stage I and II of the previous classification were merged (Ibrahim 2023).

Copper wire arteries occur as hypertension-related vascular changes in stage II according to Keith and Wagener at the back of the eye (Herold 2018).

Hypertension-related vascular changes in the fundus of the eye are referred to as "fundus hypertonicus" or "hypertensive retinopathy" and are divided into 4 stages according to Keith and Wagener (KWB):

• Stage I: In this stage, the first functional vascular changes occur in the form of:
  • Arteriolar vasoconstriction
• Stage II: In stage II, the following additional structural changes of the vessels occur:
  • Copper wire arteries with caliber irregularities
  • Salus-Gunn crossing signs at arteriovenous crossings
• Stage III: Additional damage to the retina in the form of:
  • streak hemorrhages
  • Soft exudates, so-called cotton-wool foci
  • Macular star figure (calcified foci around the macula)
• Stage IV:
  • In addition, there is also bilateral papilledema (Herold 2018)

There is also the two-stage classification of the "World Health Organization" based on the KWB classification. This differentiates between an early stage (corresponding to KWB stage I and II) and a late stage (corresponding to KWB stage III and IV) referred to as:

• hypertonic fundus
• Fundus hypertonicus malignus (Ibrahim 2023)

A further classification concerns the three stages of retinopathy according to Wong and Mitchel. Stages I and II were combined according to KWB. A distinction is made between three stages:

• Mild
• Moderate
• Malignant (Ibrahim 2023)

Copper wire arteries are arteries of the retina that appear thickened on funduscopy or dye examination of the eye (Tseichner 2024).

The prevalence of arterial hypertension in Germany, compared to other industrialized countries, is high at 55% in the age group between 35-64 years. Signs of hypertensive retinopathy are found in approx. 2-14% of non-diabetics over the age of 40 (Heimann 2010).

Copper wire arteries occur in the context of hypertensive retinopathy (Tseichner 2024).

An acute increase in blood pressure initially leads to reversible vasoconstriction in the retinal vessels. Sometimes there is also papilledema (Mehta 2024).

With prolonged hypertension, exudative vascular changes occur as a result of endothelial damage and necrosis. Over the years, wall thickening of the arterioles may become apparent (Mehta 2024).

The discoloration of the normal light reflex of the retinal vessels is caused by sclerosis and hyalinization spreading over the arterioles and thus increasing their circumference. This increasing thickening causes the light reflex to become increasingly diffuse and the retinal arteries eventually appear reddish brown (Dennis 2019).

Symptoms develop relatively late in the course of the disease and manifest themselves in the form of blurred vision or visual field defects (Mehta 2024).

Diagnosis is primarily based on anamnestic information, particularly with regard to the duration and severity of existing arterial hypertension. The diagnosis is then made by means of a funduscopy (Mehta 2024).

Even at an early stage, arteriolar constrictions with a reduction in the ratio of retinal arteriole to retinal venule can be detected on funduscopy (Mehta 2024).

In the case of poorly controlled hypertension, constrictions occur in the further course:

• Arteriovenous crossing anomalies, so-called crossing phenomena up to retinal venous branch occlusion
• Permanent narrowing of the arteries
• Arteriosclerosis with moderate vessel wall changes, the so-called copper wire arteries
• In the advanced stage of arteriosclerosis, severe vessel wall hyperplasia and thickening of so-called silver wire arteries (Mehta 2024)

• Vascular occlusions
• Epiretinal gliosis
• Exudative retinal detachment
• Retinal macroaneurysms (Buchta 2002)
• The risk of vision loss increases significantly if the patient also suffers from diabetes mellitus (Mehta 2024).

Copper wire arteries are treated primarily by regulating blood pressure (Mehta 2024).

If vision loss occurs, the retinal edema is treated with:

• Laser therapy
• Intravitreal injection of corticosteroids or other drugs such as bevacizumab, pegaptanib, ranibizumab (Mehta 2024)

Stages I and II of the KWB classification, in which copper wire arteries are present, are considered relatively unspecific, as these changes can also occur in normotensive patients. Stages III and IV, on the other hand, have a very unfavorable prognosis, as they indicate malignant hypertension, although this rarely occurs nowadays (Middeke 2005).

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10. Tseichner A, Antwerpes (2024) Copper wire artery. DocCheck Flexikon doi: https://flexikon.doccheck.com/en/copper-wire-artery