Ocular Manifestations of Preeclampsia

Retinal Microvascular Characteristics and Outcomes in Hypertensive Disorders of Pregnancy

Background Hypertensive disorders of pregnancy (HDP) is a continuum of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia in increasing severity, associated with a higher risk of complicated pregnancies and poor neonatal outcomes. This multisystem involvement can be assessed by fundoscopy, which serves as an indicator for generalized microvascular abnormalities. Our study aims to evaluate the correlation of hypertensive retinopathy with the severity of HDP and maternal and fetal outcomes. Materials and methods The study was conducted at a tertiary care hospital in Vijayapura from October 2021 to March 2022 among admitted cases of HDP. Detailed history, blood pressure (BP) measurement, obstetric examination, and fundoscopy were performed for all cases. Patients were followed up until the 10th postnatal day. The mode of delivery, birth weight, gestational age at birth, and any other neonatal outcomes were noted. Results We included 94 preeclampsia/eclampsia patients with a median age of 23 years, 51 (54.3%) being primigravida. Patients with chronic hypertension, gestational hypertension, and chronic hypertension superimposed by preeclampsia/eclampsia were excluded. The most common symptom in mothers was headache (23.4%), followed by blurring of vision (20.2%) and epigastric pain (5.3%) with a significant association (p < 0.05). Thirty-two cases (34%) had preterm deliveries with a positive association with the severity of retinopathy (p < 0.05). The magnitude of hypertensive retinopathy was 56.3% (53 cases), the severity of which significantly correlated to the severity of HDP (p < 0.05). We report 8.5% neonatal mortality and 22.3% small for gestational age (SGA) with a positive association with HDP severity (p < 0.05). There was no correlation between serum creatinine levels and the severity of retinopathy and fetal outcome. Conclusion The occurrence and severity of hypertensive retinopathy increase with increasing severity of HDP. Complaints, such as headache, blurred vision, and epigastric pain, are reported higher in cases with retinopathy. The severity of retinopathy may be used as an indicator of fetal morbidity; however, studies with large sample sizes and advanced tools are required to quantify the cause-effect relationship. The retinopathy associated with HDP resolves naturally with BP control postnatally.

Permanent Severe Visual Field Defect Following Pre-eclampsia and Multiple Ophthalmological Pathologies: A Case Report

This clinical report discusses the interplay of various pathologies that may present similar clinical manifestations, with uncertainty about the distinct impact of each one of them. The patient is a 43-year-old young Asian female with no known medical conditions. She was 33 weeks pregnant when she was admitted for an urgent c-section because of preeclampsia with HELLP syndrome. While hospitalized, she complained about the visual field's loss. A comprehensive ophthalmological examination revealed a severe concentric visual field defect along with well-reduced visual acuity and impaired color vision. Her OCT revealed a bilateral serous macular detachment related to pre-eclampsia. A brain MRI revealed a microstroke at the temporo-parieto-occipital junction (TPO), although it did not fully account for the severity of the visual field deficit. Despite the macular pathology being resolved, the visual field remained deeply impacted. A thorough and complete investigation yielded negative results, leaving the cause of the patient's deficit unknown. The patient likely had a normal pressure glaucoma. Additionally, multifactorial bilateral microvascular ischemic neuropathy (caused especially by high myopia) has significantly affected her visual field. Furthermore, it is also probable that the patient had genetic neuropathy. Initial genetic testing was negative; however, due to the high suspicion of a genetic component, a retest was conducted, and the results were not conclusive. This case represents a highly unusual case of a profoundly affected visual field with no apparent identified cause. This is a notable example of the potential interaction of various local and systemic pathologies that can manifest with similar clinical presentations.

Pregnancy and the eye: What do we need to watch out for? A review

Pregnancy causes changes in all body systems, including the eye. The eye can undergo physiological and pathological changes in pregnancy. Some changes exacerbate pre-existing eye conditions while other conditions manifest for the first-time during pregnancy. Early recognition and management are essential to prevent sight threatening complications. In addition, some obstetric complications can be associated with ophthalmic signs. Prompt recognition of these eye findings may be life saving for both the mother and the foetus. The aim of this article is to present potential ocular complications in pregnancy and outline the appropriate management to preserve sight and maintain maternal and foetal safety. The safety of the use of common ophthalmological medications will also be discussed.

Bilateral serous retinal detachment in pre-eclampsia a rare but favorable complication: case report

Pre-eclampsia is a serious pregnancy-related condition that can cause damage to multiple organs, including the eyes. While pre-eclampsia is commonly associated with the narrowing of the retinal arteries, more severe complications such as cortical blindness, optic neuropathy, and serous retinal detachment (SRD) can occur in rare cases. This case report describes a 26-year-old primiparous woman who presented with headaches, bilateral visual fog, and tinnitus and was diagnosed with pre-eclampsia based on elevated blood pressure and proteinuria. Despite receiving antihypertensive treatment, the patient's visual symptoms worsened, prompting an emergency cesarean section. An ophthalmological examination revealed bilateral macular SRD. SRD in pre-eclampsia is a rare complication that can occur even in the immediate post-partum period, with a favorable prognosis. It should be noted that any pre-eclamptic patient presenting with visual symptoms in the third trimester or post-partum should be considered for serous retinal detachment.

A Correlational Study of Ophthalmic Artery Doppler Parameters and Maternal Blood Pressure in Normotensive and Pre-eclamptic Pregnancies at a Tertiary Care Hospital

Background Hypertensive disorders are one of the most common complications of pregnancy. This study aimed to investigate the relationship between ophthalmic artery Doppler indices and preeclampsia development and evaluate differences in these indices between normotensive and hypertensive pregnancies. Methods A hospital-based cross-sectional observational study was conducted involving a sample size of 80 pregnant women: 40 normotensive and 40 preeclamptic. The participants' ophthalmic artery Doppler parameters were evaluated using ultrasonography. Various clinical and demographic factors were also collected for analysis. Results Significant differences in the pulsatility index (PI) and end-diastolic volume (EDV) of the ophthalmic arteries were found between the normotensive and preeclamptic participants (p < 0.05). An inverse correlation was observed between the ophthalmic artery PI (OAPI) and mean maternal arterial pressure, suggesting reduced orbital vascular resistance and increased orbital flow. Moreover, the decrease in PI was more significant in severely preeclamptic women than in mildly preeclamptic and normotensive women. The findings indicated a significant correlation between ophthalmic artery Doppler parameters and the development of preeclampsia. The decrease in OAPI was particularly profound in women with severe preeclampsia. However, the study was limited by its small sample size and the lack of matching of participants based on maternal age, gestational age, and other factors. Conclusions The study results suggest that ophthalmic artery Doppler parameters, mainly PI and EDV, could serve as reliable indicators for the development of preeclampsia. Given their safety, cost-effectiveness, and accessibility, these parameters can help differentiate between preeclamptic and normotensive pregnancies in late gestation. Further research with larger sample sizes and matched participant groups is recommended for more conclusive results.

Ocular Manifestations in Pregnancy-Induced Hypertension at a Tertiary Level Hospital in Karnataka, India

Introduction Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of previously known hypertension. PIH is a common and serious complication accompanying pregnancy. Pre-eclampsia and eclampsia are multisystem disorders that can involve end organs like kidneys, liver, eyes, haematopoietic system and placenta. Though ocular involvement is not uncommon in PIH, ocular examination is not always done in all cases of PIH. Timely detection of changes in retinal vasculature can be a hint to the underlying changes in the vascular system of the various end organs of the human body including placental circulation. Adequate management of PIH is very important for both fetal and maternal well-being. Aim To evaluate the ocular manifestations in women affected by PIH (mild pre-eclampsia, severe pre-eclampsia and eclampsia) presenting to a tertiary-level hospital. Methodology This was a hospital-based cross-sectional study carried out for a period of one year at a tertiary-level hospital. A total of 120 subjects diagnosed as cases of pre-eclampsia/eclampsia admitted to the eclampsia ward of the obstetric unit formed the study population. After taking history, a detailed ocular examination was done for all patients and the findings were noted. Results The mean age of the study population was 31.91 ± 4.38 years (range 21 to 39 years). The mean gestational age was 30.89 ± 3.98 weeks. Fifty-three (44.17%) were primigravida, 64 (53.33%) were multiparous, and three (2.5%) were grand multiparous. Sixty-two (51.67%) had mild pre-eclampsia, 50 (41.67%) had severe pre-eclampsia and eight (6.67%) had eclampsia. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) recorded in the study were 155.32 ± 11.89 mmHg and 104.3 ± 11.41 mmHg respectively. Ocular symptoms were present in 43 (35.83%) participants. Blurring of vision (19.17%) was the commonest ocular symptom observed in the study population followed by photopsia (13.33%), diplopia (9.17%), intermittent loss of vision (5.83%), ocular pain (6.67%), and scotoma (1.67%). Systemic symptoms included headache (11.67%), epigastric pain (3.33%), and nausea (5%). Anterior segment findings like conjunctival congestion, lid edema, and subconjunctival hemorrhage each accounted for 1.67% of the study population. Fundal changes were present in 33.33% of cases. Arteriolar narrowing was the commonest fundal finding amounting to 15.83%, followed by arteriovenous (AV) crossing changes also in 15.83%, cotton wool spots in 5.83%, retinal haemorrhages in 8.33%, papilledema in 2.5%, and choroidal infarcts in 1.67% participants. Grade 1 hypertensive retinopathy was observed in 15.83% of participants, grade 2 in 8.33% of participants, grade 3 in 6.67% of participants and grade 4 in 2.5% of participants. The mean SBP and mean DBP were high among those with fundal changes (163.35 ± 10.25 mmHg and 111.15 ± 10.29 mmHg) compared to those without fundal changes (151.3 ± 10.58 mmHg and 100.88 ± 10.41 mmHg). This was statistically significant. Proteinuria showed significant correlation with retinal changes. Conclusion The retinal vasculature changes correlate with the severity of hypertension, hence, it is very important to seek ophthalmologic opinion for evaluation, diagnosis and prompt management of PIH.

Visual morbidity and spectrum of ophthalmic changes in pregnancy induced hypertension

Aim

To determine the prevalence of ocular changes in pregnancy-induced hypertension (PIH) and co-relate the ophthalmic changes and severity of the disease with visual outcome.

Methods and Material

This is a retrospective study conducted from a hospital-based cohort of pregnant women, who delivered from June 2018 to December 2020. A total of 153 patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward were included in this study. History with regard to age, parity, gravida, gestational age, medical history, and ocular findings were noted from the patient's case records. Anterior segment examination, dilated fundus evaluation, blood pressure (BP) recordings, urine proteinuria were done. All data were analyzed using the satistical package for social science (SPSS) program.

Results

Out of 153 patients, 78 (50.98%) were primigravida, 55 (35.95%) were gravida 2, and 20 (13.07%) were multigravida. Gestational age ranged from 23-40 weeks. Ocular changes were seen in 57% of the PIH patients. Hypertensive retinopathy was seen in 23.53% of PIH patients with a mean age of 29.06 ± 4.36 years. Grade 1 hypertensive retinopathy was the most common manifestation in PIH patients (51.16%). The visual loss occurred in 72% of eclampsia and12% of pre-eclampsia which was statistically significant (P = 0.03). Papilledema was seen in 6% and refractive error in 41% of the patients.

Conclusions

Ocular examination of PIH patients reveals important objective information concerning the disorder. The presence of retinal change is a marker of the severity of PIH and is the most common ocular feature. Detection of progression of these changes reflects ischemic changes of the placenta. Fundus examination in PIH patients is important to predict adverse fetal outcomes, and risks to mother's life.

Preeclampsia and eclampsia: the conceptual evolution of a syndrome

Preeclampsia, one of the most enigmatic complications of pregnancy, is considered a pregnancy-specific disorder caused by the placenta and cured only by delivery. This article traces the condition from its origins-once thought to be a disease of the central nervous system, recognized by the occurrence of seizures (ie, eclampsia)-to the present time when preeclampsia is conceptualized primarily as a vascular disorder. We review the epidemiologic data that led to the recommendation to use diastolic hypertension and proteinuria as diagnostic criteria, as their combined presence was associated with an increased risk of fetal death and the birth of small-for-gestational-age neonates. However, preeclampsia is a multisystemic disorder with protean manifestations, and the condition can be present even in the absence of hypertension and proteinuria. Toxins gaining access to the maternal circulation have been proposed to mediate the clinical manifestations-hence, the term "toxemia of pregnancy," which was used for several decades. The search for putative toxins has challenged investigators for more than a century, and a growing body of evidence suggests that products of an ischemic or a stressed placenta are responsible for the vascular changes that characterize this syndrome. The discovery that the placenta can produce antiangiogenic factors, which regulate endothelial cell function and induce intravascular inflammation, has been a major step forward in the understanding of preeclampsia. We view the release of antiangiogenic factors by the placenta as an adaptive response to improve uterine perfusion by modulating endothelial function and maternal cardiovascular performance. However, this homeostatic response can become maladaptive and lead to damage of target organs during pregnancy or the postpartum period. Early-onset preeclampsia has many features in common with atherosclerosis, whereas late-onset preeclampsia seems to result from a mismatch of fetal demands and maternal supply, that is, a metabolic crisis. Preeclampsia, as it is understood today, is essentially vascular dysfunction unmasked or caused by pregnancy. A subset of patients diagnosed with preeclampsia are at greater risk of the subsequent development of hypertension, ischemic heart disease, heart failure, vascular dementia, and end-stage renal disease. However, these adverse events may be the result of a preexisting vascular pathologic process; it is not known if the occurrence of preeclampsia increases the baseline risk. Therefore, the understanding, prediction, prevention, and treatment of preeclampsia are healthcare priorities.

Relationship between the sFlt-1/PlGF ratio and the optical coherence tomographic features of chorioretina in patients with preeclampsia

This study aimed to evaluate the correlation between ophthalmologic factors and the serologic indicator soluble fms-like tyrosine kinase 1 (sFlt-1): placental growth factor (PlGF) ratio in patients with preeclampsia using optical coherence tomography (OCT) and OCT angiography (OCT-A). A total of 52 pregnant patients (104 eyes) diagnosed with preeclampsia were recruited during their hospital stay. The associations between the sFlt-1/PlGF ratio and chorioretinal measurements, including the choroidal thickness (CT), foveal avascular zone, vascular density, and ganglion cell layer+ were evaluated. Central and nasal subfield CT of the left eye (p = 0.039; p = 0.010) and nasal subfield CT of the right eye (p = 0.042) were lower in the high sFlt-1/PlGF ratio group (≥38). Pearson’s correlation test showed a negative correlation between the sFlt-1/PlGF ratio and central subfield CT; however, this was not statistically significant (p = 0.648). Linear regression analysis revealed a significant association between the sFlt-1/PlGF ratio and central subfield CT (β coefficient, -6.66; p = 0.01) and between sFlt-1 and central subfield CT (β coefficient, -5.65; p = 0.00). Thus, an increase in the sFlt-1/PlGF ratio resulted in a decrease in central subfield CT.

Optical coherence tomography angiography findings in preeclampsia

OBJECTIVES

To investigate vascular density analysis in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), peripapillary vascular density analysis (PPCVD), and peripapillary retinal nerve fiber thickness analysis (PPRNFL) using optical coherence tomography angiography (OCTA) in pregnant women with preeclampsia and to compare the obtained values with healthy pregnant and nonpregnant healthy individuals.

METHODS

A total of 98 pregnant women (55 had preeclampsia, 43 were healthy pregnant women) and 38 healthy nonpregnant women of reproductive age were included in the study. The patients were divided into three groups. Group 1 consisted of pregnant women with preeclampsia, group 2 comprised healthy pregnant women without preeclampsia, and group 3 consisted of healthy women who were not pregnant. All participants underwent a comprehensive ophthalmologic examination including OCTA.

RESULTS

Superficial foveal density (SFD) and deep foveal density (DFD) were lower in group 1 than in group 3 (p = 0.033, p = 0.041, respectively). Deep parafoveal density (DPD), deep temporal density (DTD), and deep superior density (DSD) values were lower in group 1 than in group 2 and group 3 (p = 0.001). PPRNFL superior and mean values were higher in group 1 and group 2 than in group 3 (p = 0.022, p = 0.029, respectively). The mean superior and inferior RPCVD values were significantly higher in group 1 than in group 2 and group 3 (p = 0.001, p = 0.043, and p = 0.001, respectively).

CONCLUSIONS

In preeclampsia, OCTA shows changes in the microvascular structure of the retina, even without retinopathy findings on biomicroscopy examination.

Neuropathological complications associated with hypertensive disorders of pregnancy

Objective: Hypertensive disorders in pregnancy particularly severe preeclampsia and eclampsia result in significant maternal and neonatal morbidity and mortality. Many of these misfunctions can aggravate some of the neuropathological complications of hypertensive disorders during pregnancy. Method: In this review article, we described some of the neuropathological complications associated with hypertensive disorders of pregnancy. Results and conclusion: It is explained how the possible mechanism of neuropathological events triggers some of the complications associated with hypertensive disorders of pregnancy. Conclusion: A strong plea is made for the early detection of high blood pressure, its immediate control with rapid acting anti-hypertensive agents if necessary and timeous delivery of fetus as the exact pathogenesis of preeclampsia remains unknown.

The Role of Melatonin in Oxidative Stress, DNA Damage, Apoptosis and Angiogenesis in Fetal Eye under Preeclampsia and Melatonin Deficiency Stress

Aim: The aim of this study was to investigate the possible mechanisms of ocular damage induced by pinealectomy (PNX) and preeclampsia (PE), and to determine the cellular and molecular effects of melatonin treatment on oxidative stress, DNA damage, molecular chaperone responses, induction of apoptosis and angiogenesis in the fetal eye of both PNX and PNX+PE animals. Material and Methods: We analysed therapeutic potential of melatonin on fetal eye damage in PNX and PNX+PE animals using Malondialdehyde (MDA), Random Amplified Polymorphic DNA (RAPD), qRT-PCR and Western blot assays. Results: Our study presents three preliminary findings: (a) in fetal eye tissues, PNX and PNX+PE significantly induce oxidative damage to both DNA and protein contents, leading to a dramatic increase in caspase-dependent apoptotic signalling in both mitochondrial and death receptor pathways; (b) the same conditions trigger hypoxia biomarkers in addition to significant overexpression of HIF1-α, HIF1-β, MMP9 and VEGF genes in the fetal eye; (c) finally, melatonin regulates not only the expression of genes encoding antioxidant enzymes and increase in DNA damage as well as lipid peroxidation but also limits programmed cell death processes in the fetal eye of PNX and PNX+PE animals . Furthermore, melatonin can relatively modulate genes in the HIF1 family, TNF-α and VEGF, thus acting as a direct anti-angiogenic molecule. In conclusion, both PNX and PNX+PE induce ocular damage at both cellular and molecular levels in fetal eye tissue of rats. Conclusion: Our results clearly indicate the potential of melatonin as a preventative therapeutic intervention for fetal ocular damage triggered by both PNX and PNX+PE.

Ultrasound assessment of visual loss during severe preeclampsia: a case report

Bilateral retinal detachments and cortical blindness are rare complications of preeclampsia and the association of the two pathologies is exceptional. We report the case of a preeclamptic patient who presented with an acute bilateral vision loss. Besides, her ocular ultrasound revealed bilateral retinal detachments and an elevated optic nerve sheath diameter. The patient underwent an urgent cesarean section. Subsequently, magnetic resonance imaging and ocular fundus examination confirmed the diagnosis.

The prevalence of retinal and optical coherence tomography findings in preeclamptic women

PURPOSE

To evaluate retinal and optical coherence tomography findings and establish their prevalence in preeclamptic women.

METHODS

Twenty-seven preeclamptic women who underwent clinical examinations with both slit-lamp biomicroscopy and optical coherence tomography were prospectively studied.

RESULTS

Three of the 4 women (14.8%) identified by clinical examinations as having retinal findings related to preeclampsia had visual disturbances. Optical coherence tomography revealed retinal pathology in 2 women (7.4%) consisting of retinal edema, subretinal fluid, photoreceptors irregularities, and lesions at the retinal pigment epithelium level (Elschnig spots). The mean retinal nerve fiber layer thickness was significantly higher in women with pathologic funduscopic findings (P = 0.009) than in women with normal eye examinations. All women with ocular findings had severe preeclampsia and higher systolic blood pressure than women without ocular findings (P = 0.03).

CONCLUSION

The prevalence of retinal involvement is high in severe preeclampsia and low in asymptomatic preeclampsia. Preeclamptic women diagnosed as having ocular involvement should be evaluated and monitored by optical coherence tomography, provided that their systemic condition allows it. Findings of retinal nerve fiber layer thickening in these women may indicate occult central nervous system involvement.

Partial HELLP syndrome with unilateral exudative retinal detachment treated conservatively

Peripartum vision loss, an uncommon, often reversible complication of pregnancy usually occurs in the setting of pre-eclampsia or eclampsia. The HELLP syndrome is characterized by hypertension, elevated liver enzymes and low platelets. This is a rare case of unilateral exudative retinal detachment associated with the Partial HELLP syndrome that occurred after delivery in a 23-year-old Indian woman. The retinal detachment subsequently reattached with good visual improvement under conservative treatment. This case highlights the importance of early intervention by the ophthalmologist when pregnant women complain about visual symptoms.

Evaluation of the macula, retinal nerve fiber layer and choroid in preeclampsia, healthy pregnant and healthy non-pregnant women using spectral-domain optical coherence tomography

OBJECTIVE

To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectral-domain optical coherence tomography (SD-OCT) in preeclampsia and compare with healthy pregnant and healthy non-pregnant controls.

METHOD

The study population included healthy pregnant control group (n: 25), healthy non-pregnant control group (n: 26) and study group with preeclampsia (n: 27). Retinal thickness parameters were measured by SD-OCT.

RESULTS

There was a statistically significant difference among all of the groups for choroidal thickness (p < 0.001). Choroidal thickness in preeclamptic women was significantly thinner than healthy pregnant women. The most thick choroid layer was detected in healthy pregnant group, and also the most thin choroidal thickness was detected in healthy non-pregnant group (p < 0.001). Macular central subfield and foveal center thickness were significantly thinner in preeclamptic study and healthy pregnant groups than healthy non-pregnant group (p < 0.001). However, there was no statistically significant difference between preeclamptic study group and healthy pregnant group for both macular central subfield and foveal center thickness. Average of RNFL thickness was significantly thicker in healthy pregnant group than healthy non-pregnant group (p = 0.004).

CONCLUSIONS

This study revealed that choroidal thickness measured using SD-OCT increased in women with preeclampsia and healthy pregnant women but the increase in choroidal thickness in preeclampsia was lower than the healthy pregnant controls. This lower rise in choroidal thickness can be generally attributed to the markedly increased systemic vascular vasospasm secondary to preeclampsia.

[Hypertensive changes of the fundus]

Systemic hypertension affects approximately 25 % of the population worldwide and is the most important preventable risk factor for cardiovascular diseases. Hypertension-related fundus abnormalities can be classified into hypertensive retinopathy, choroidopathy, and optic neuropathy. Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer. The use of a detailed grading system based on the severity of vascular constriction is not practicable as arteriosclerotic changes are common among elderly people. Therefore, early stages with pure vascular pathology should be differentiated from severe forms of hypertensive retinopathy with parenchymal changes of the fundus. Screening the retina for hypertensive changes is essential in cases of severe systemic hypertension, acute visual impairment, diabetes mellitus and pregnancy.

[Retinal detachment in preeclampsia: a series of three cases]

Three Afro-Caribbean women presented with a decreased visual acuity associated with preeclampsia during the third trimester of pregnancy. Fundus examination exhibited a serous retinal detachment (SRD). Postpartum fluorescein and indocyanine green angiography indicated subretinal leakage induced by choroidal ischemia. The three patients had an improvement of their visual acuity to 20/20 within 2 to 3 months of the onset of symptoms. Fundus exam and fluorescein angiography showed no further abnormality. SRD in preeclampsia may have an impressive acute presentation but seems to resolve favorably spontaneously without intervention, upon delivery. Nevertheless, SRD must be considered to be a sign of imminent worsening of preeclampsia.

The eye and visual system in the preeclampsia/eclampsia syndrome: What to expect?

The preeclampsia/eclampsia syndrome is a multisystem disorder that can include cardiovascular changes, hematologic abnormalities, hepatic and renal impairment, and neurologic or cerebral manifestations. It also can affect the eye and visual pathways. Visual symptoms concern up to 25% of patients with severe preeclampsia and 50% of patients with eclampsia. This review discusses the ophthalmic complications of preeclampsia/eclampsia with focus on the hypertensive retinopathy, exudative retinal detachment and cortical blindness.

OCT-3 Study of Serous Retinal Detachment in a Preeclamptic Patient

We report optical coherence tomography-3 (OCT-3) of retinal disorders in acute preeclampsia. A 33-year-old woman developed mind hypertension (170/90 mm Hg) and proteinuria in the 28th week of pregnancy. The patient complained of sudden and severe visual acuity decrease. Fundus exam showed bilateral serous retinal detachment at the macula area. OCT-3 exam demonstrated subretinal and intraretinal fluid. Bilateral serous retinal detachment is an unusual finding of preeclampsia of unknown aetiology. Intense arteriolar vasospasm has been implicated in the pathogenesis of the serous retinal detachment. OCT-3 showed the presence of both subretinal and intraretinal fluid during the acute phase of preeclampsia.

Retinopathy in preeclampsia: association with birth weight and uric acid level

PURPOSE

In a retrospective study of patients with preeclampsia and patients with pregnancy-induced hypertension (PIH) who delivered at term, the association of retinopathy with various clinical and laboratory manifestations and fetal birth weight was evaluated.

METHODS

Medical records of patients with preeclampsia and patients with PIH who delivered at term between January 2003 and December 2004 were reviewed. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic blood pressure (BP), fetal birth weight, and various biochemical parameters. Multivariable linear regression was used for statistical analysis. P < or = 0.05 was considered significant.

RESULTS

Forty patients were included in the preeclampsia group (study group) as well as in the PIH group (control group). Severity of retinopathy was found to be inversely related to fetal birth weight (P = 0.044) and positively related to serum uric acid level (P = 0.022) in the preeclampsia group. All other variables in the preeclampsia group including systolic BP (mean, 154.6 mmHg; P = 0.792) and diastolic BP (mean, 105.7 mmHg; P = 0.102) were found to have no significant association with retinopathy. In the PIH group, none of the parameters analyzed were significantly associated with ocular changes.

CONCLUSIONS

The severity of retinopathy in preeclampsia is directly related to the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy might be independent of systemic BP.

Fetal birthweight and diastolic blood pressure: association with retinopathy in severe preeclampsia

PURPOSE

To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia.

METHODS

Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value < or =0.05 was considered significant.

RESULTS

The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SPshowed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy.

CONCLUSIONS

Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiencyand intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.

Bilateral vision loss reveals occult pregnancy

Preeclampsia is a life-threatening disorder for both the mother and fetus. A 43-year-old woman presented with a 1-day history of bilateral decreased vision and no systemic complaints. Physical examination revealed an abdominal mass and further diagnostic testing revealed a previously unknown pregnancy. Admission resulted in an emergency cesarean section for fetal distress. This case provides a unique primer of the various diagnostic tests and their results in the diagnosis of preeclampsia. It also highlights the critical role ophthalmologists may play in the diagnosis of this potentially devastating disease.

Ocular disease in pregnancy

PURPOSE OF REVIEW

Pregnancy may cause ocular changes, both physiologic and pathologic, and may be associated with the development of new disease or may alter the course of preexisting disease. This paper discusses these changes and reviews diabetic retinopathy, uveitis, preeclampsia, cortical blindness and central serous chorioretinopathy.

RECENT FINDINGS

Recent reports have contributed to our understanding of the pathophysiology of diabetic retinopathy and cortical blindness associated with preeclampsia, the impact of pregnancy on the course of inflammatory eye disease, and the use of optical coherence tomography in following central serous chorioretinopathy in pregnant women.

SUMMARY

This improved understanding of the pathophysiology of ocular disease in pregnancy and the impact of pregnancy on the course of preexisting ocular disease offers the opportunity for meaningful counseling of women who are pregnant or planning to become pregnant.

Study of lens autofluorescence by fluorophotometry in pregnancy

Lens autofluorescence originates from an accumulation of fluorescent substances such as the tryptophan-derived residues and protein aggregations, which are associated with the preclinical progress of cataractogenesis, diabetes and lens aging. Our purpose is to determine if pregnancy alters the typical constituents of the lens autofluorescence. Fifteen healthy pregnant women (22 eyes) who were in their third trimester of pregnancy and 23 age-matched healthy controls (37 eyes, non-pregnant females). Lens autofluorescence, lens transmission and corneal autofluorescence were studied with fluorophotometry. The lens autofluorescence values were 358+/-151 ng ml(-1) in the control group and 201+/-110 ng ml(-1) in the pregnants women. The difference was significant (p=0.0074). Lens transmission values were 0.93+/-0.02 ng ml(-1) in the control group and 0.94+/-0.02 ng ml(-1) in the pregnants women: the difference was not significant. Corneal autofluorescence values were 21.9+/-7.5 ng ml(-1) in the control group and 18.2+/-5.8 ng ml(-1) in the pregnant women. The difference was not significant. Our study showed a significant decrease in lens autofluorescence in pregnant women compared to a normal population. The decrease can be partly attributed to the aqueous component of the lens that increases significantly during the final trimester of pregnancy and that this provokes a dilution of the fluorescent substances.