Enhanced depth imaging optical coherence tomography findings associated with serous retinal detachment in preeclampsia

Bilateral Serous Retinal Detachment and Posterior Reversible Encephalopathy Syndrome Precipitated by Eclamptic Attack

Eclampsia is a severe hypertensive disease accompanied by tonic-clonic convulsions in the second half of pregnancy or during delivery in the absence of other aetiology. The association between eclampsia and serous retinal detachment is not common. We report a case of a 20-year-old primipara with eclampsia who developed bilateral exudative retinal detachment after delivery. Brain computed tomography (CT) reported findings in the occipital lobes consistent with posterior reversible encephalopathy syndrome. A few weeks after delivery, there was spontaneous resorption of subretinal fluid and complete resolution of bilateral serous retinal detachment with residual signs of choroidal ischemia, including Elschnig’s spot, Siegrist streak and some pigmentary changes in the retinal pigment epithelium. Visual acuity returned to normal in both eyes and there was complete resolution of the disease.

Serous retinal detachment in preeclampsia and malignant hypertension

OBJECTIVES

To compare and evaluate the characteristics of hypertensive choroidopathy with serous retinal detachment in preeclampsia and malignant hypertension (HTN) and explore choroidal ischemia as a pathogenesis using multimodal imaging.

METHODS

A retrospective multicenter case series. Medical charts were reviewed. Clinical characteristics and multimodal imaging, including optical coherence tomography (OCT) and OCT angiography (OCTA), were evaluated.

RESULTS

Fifty-three eyes of 29 preeclampsia patients and 45 eyes of 24 HTN patients were included. There were no differences in age, follow-up duration, baseline visual acuity, central macular thickness (CMT), or subfoveal choroidal thickness (CT) between the two groups. Blood pressure parameters, including systolic blood pressure, diastolic blood pressure, and pulse rate, were significantly higher in the HTN group. After serous retinal detachment resolved, both CMT (p < 0.001) and CT (p = 0.003) decreased more in the preeclampsia group. Hypertensive retinopathy features, including hemorrhage, exudates, cotton-wool spots, and optic disc edema, were predominantly found in the HTN group (p = 0.001). Final visual acuity was better in the preeclampsia group than in the HTN group (p = 0.048). Poor visual prognostic factors included the presence of retinopathy features (p = 0.005) and retinal detachment in the macula (p = 0.017).

CONCLUSION

Choroidal circulation may be affected earlier than retinal circulation by elevated blood pressure, presumably because of anatomical differences and autoregulatory mechanisms in the retinal vasculature. Serous retinal detachment with hypertensive choroidopathy presented with choroidal thickening that decreased after resolution, but the residual flow defects observed in the choriocapillaris on OCTA confirmed the long-hypothesized notion that ischemia is a mechanism underlying hypertensive choroidopathy.

Elschnig's Spots in the Acute and Remission Stages in Preeclampsia: Spectral-Domain Optical Coherence Tomographic Features

Purpose

Preeclampsia is a multisystem disorder defined as new onset of hypertension and proteinuria during the second half of pregnancy. Serous retinal detachment (SRD) is a known complication of preeclampsia caused by choroidal ischemia and subsequent disruption of blood-retinal barrier. Poor perfusion of the choriocapillaris causes Elschnig's spots. We aim to describe distinctive optical coherence tomography (OCT) features of a cluster of Elschnig's spots in a patient with severe preeclampsia during the acute and remission stages. We also present a summary of OCT features of preeclampsia patients with SRD.

Methods

Descriptive case report.

Results

V-shaped adhesions were observed at the location of each of the Elschnig's spots, the center of which showed disruption of the outer retinal bands (external limiting membrane, inner segment/outer segment junction layer), and the V-shaped outer parts remained tethered to retinal pigment epithelium (RPE)-Bruch's complex by hyperreflective exudate on the surface of RPE. These features parallel the histopathologic features described earlier. In an experimental model, Elschnig's spots showed a gradient of RPE damage from the center to the periphery, where RPE was necrotic in the center and edematous in the periphery. Three months later, spectral-domain OCT (SD-OCT) showed focal RPE elevations at the location of each of the Elschnig's spots.

Conclusions

We illustrate the distinctive SD-OCT features of a cluster of Elschnig's spots in the acute and chronic stages of preeclampsia and demonstrate the correlation with the previously described histopathologic features. Despite the favorable visual outcome, irreversible tissue damage may occur, necessitating prompt diagnosis and immediate therapeutic intervention.