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Sivakumaran P, Khare M, Kumar P. A Case Report of Bilateral Exudative Retinal Detachment in Severe Pre-eclampsia. Cureus 2024; 16:e56791. [PMID: 38650803 PMCID: PMC11034995 DOI: 10.7759/cureus.56791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
We report a case of a 31-year-old gravida 2 para 1 female presenting to the optician with a two-week history of blurred vision and persistent headaches at 29 weeks gestation. Visual acuity on presentation was 6/100 in the right eye and 6/24 in the left eye. Fundoscopy of both eyes revealed serous retinal detachment in the absence of background retinal changes. On urgent admission to the maternity assessment unit, blood pressure was 189/126 mmHg and urine dipstick revealed 4+ proteinuria. Due to recurrent poor foetal heart rate variability on cardiotocography monitoring, an emergency caesarean was conducted. Sixteen hours following delivery, visual symptoms had improved, and clinical examination revealed normal blood pressure. An optical coherence tomography scan performed three months later was dry bilaterally with minor retinal pigment epithelium clumping. Serous retinal detachment involves the separation of the neurosensory retinal layer from the underlying retinal pigment epithelium. It is rare in pre-eclampsia but can be seen in patients with severe disease. The presentation of serous retinal detachment includes acute visual loss, reduced visual acuity, floaters, and flashing lights appearing in the vision. Although alarming on initial presentation, resolution is commonly seen within a couple of days postpartum. The pathogenic mechanism for serous retinal detachment development is widely discussed and thought to include changes to the choroidal circulation. Overall, although often self-resolving, a move to thorough antenatal care and vigilant monitoring in pre-eclamptic women is vital to prevent complications like this from occurring.
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Affiliation(s)
| | - Manjiri Khare
- Maternal-Fetal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Periyasamy Kumar
- Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Silverman RH, Urs R, Wapner RJ, Valenzuela IA, Coleman HR, Bearelly S. Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2815-2824. [PMID: 37605863 PMCID: PMC10840834 DOI: 10.1002/jum.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). METHODS Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. RESULTS In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. CONCLUSIONS Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.
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Affiliation(s)
| | - Raksha Urs
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | | | - Hanna R. Coleman
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Irving Medical Center
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Shah P, Maitra N, Vaishnav P, Dhruv J, Shyam TS, Pandya P. Performance of HDP-Gestosis Score and Ophthalmic Artery Doppler in Prediction of Pre-eclampsia. J Obstet Gynaecol India 2023; 73:43-50. [PMID: 37916023 PMCID: PMC10616013 DOI: 10.1007/s13224-023-01799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/16/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose of Study To study the predictive accuracy of maternal characteristics, mean arterial pressure, uterine artery doppler and maternal ophthalmic artery doppler in second trimester for subsequent development of pre-eclampsia. Methods A prospective cohort study of 440 women at 19-24 weeks' gestation. It included recording of maternal demographic characteristics and calculation of HDP Gestosis Score, measurement of MAP and ultrasound evaluation for fetal anatomy, Uterine artery doppler and maternal ophthalmic artery doppler. The mean Peak Systolic Velocity ratio was obtained by taking two sets of reading from both eyes. The statistical analysis was done using independent t-test for quantitative variables and chi-square test, Fisher's exact test for qualitative variables and Area Under Curve was obtained at 10% False Positive Rate. Results Among 440 pregnant women, 43(10.8%) developed Hypertensive Disorder of Pregnancy (8 early onset PE, 16 late onset PE and 19 GHTN) and 42 were lost to follow up, with an incidence rate of 10.8%. Combination of Gestosis Score + OAD PSV Ratio had highest AUC of 0.73. Whereas combination of Gestosis Score + MAP + UtAPI + OAD-PSV Ratio had highest sensitivity of 97.67%. The OAD PSV ratio improved detection rate of Gestosis Score (from 90 to 100%) for prediction of development of PE, especially Preterm PE at 10% FPR. Conclusion Maternal Ophthalmic artery doppler study significantly improved prediction of development of PE at 19-24 weeks' gestation, both independently as well as in combination with HDP-Gestosis Score, MAP and uterine artery doppler.
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Affiliation(s)
- Pooja Shah
- Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Baroda, India
| | - Nandita Maitra
- Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Baroda, India
| | - Palak Vaishnav
- Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Baroda, India
| | - Jinal Dhruv
- Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Baroda, India
| | - Twinkle Sara Shyam
- Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Baroda, India
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Kumari N, Ranjan RK, Rai N, Xalxo AR, Toppo SK, Ram PN. A Correlational Study of Ophthalmic Artery Doppler Parameters and Maternal Blood Pressure in Normotensive and Pre-eclamptic Pregnancies at a Tertiary Care Hospital. Cureus 2023; 15:e40713. [PMID: 37485119 PMCID: PMC10359754 DOI: 10.7759/cureus.40713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
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.
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Affiliation(s)
- Neha Kumari
- Radiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | | | - Nisha Rai
- Radiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Anima R Xalxo
- Radiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Suresh K Toppo
- Radiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Paras Nath Ram
- Radiology, Rajendra Institute of Medical Sciences, Ranchi, IND
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Kusuma RA, Nurdiati DS, Al Fattah AN, Danukusumo D, Abdullah S, Sini I. Ophthalmic artery Doppler for pre-eclampsia prediction at the first trimester: a Bayesian survival-time model. J Ultrasound 2023; 26:155-162. [PMID: 35917093 PMCID: PMC10063770 DOI: 10.1007/s40477-022-00697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop a Bayesian survival-time model for the prediction of pre-eclampsia (PE) at the first trimester using a combination of established biomarkers including maternal characteristics and history, mean arterial pressure (MAP), uterine artery Doppler pulsatility index (UtA-PI), and Placental Growth Factor (PlGF)) with an ophthalmic artery Doppler peak ratio (PR) analysis. METHODS The receiving operator curve (ROC) analysis was used to determine the area under the curve (AUC), detection rate (DR), and positive screening cut-off value of the model in predicting the occurrence of early-onset PE (< 34 weeks' gestation) and preterm PE (< 37 weeks' gestation). RESULTS Of the 946 eligible participants, 71 (7.49%) subjects were affected by PE. The incidences of early-onset and preterm PE were 1% and 2.2%, respectively. At a 10% false-positive rate, using the high-risk cut-off 1:49, with AUC 0.981 and 95%CI 0.965-0.998, this model had an 100% of DR in predicting early-onset PE. The DR of this model in predicting preterm PE is 71% when using 1:13 as the cut-off, with AUC 0.919 and 95%CI 0.875-0.963. CONCLUSION Combination ophthalmic artery Doppler PR with the previously established biomarkers could improve the accuracy of early and preterm PE prediction at the first trimester screening.
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Affiliation(s)
- Raden Aditya Kusuma
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
- Indonesian Prenatal Institute, Jakarta, Indonesia
| | - Detty Siti Nurdiati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Adly Nanda Al Fattah
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
| | - Didi Danukusumo
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
| | - Sarini Abdullah
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Sini
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- IRSI Research and Training Centre, Jakarta, Indonesia
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Saleh M, Naemi M, Aghajanian S, Saleh M, Hessami K, Bakhtiyari M. Diagnostic value of ophthalmic artery Doppler indices for prediction of preeclampsia at 28-32 weeks of gestation. Int J Gynaecol Obstet 2023; 160:120-130. [PMID: 35696254 DOI: 10.1002/ijgo.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the diagnostic value of ophthalmic artery Doppler indices in predicting preeclampsia along with other markers in the third trimester of pregnancy. METHODS Normotensive pregnancies were included during 28-32 weeks of gestation to undergo uterine and ophthalmic artery Doppler ultrasound. Maternal and fetal characteristics were documented at the visit between the 28 and 32 weeks of gestation, and pregnancy-associated plasma protein A (PAPP-A) values in the first trimester were collected to be integrated into a multiparametric prediction model. RESULTS Of 795 included participants, 48 cases progressed to preeclampsia. All assessed ophthalmic Doppler parameters including first and second peak systolic velocities (PSVs), second to first peak ratio (PR), and pulsatility index (PI), were statistically different in patients who developed preeclampsia later on. The average PR (sensitivity: 100% [95% CI, 0.81-1.00]; specificity: 90% [95% CI, 0.86-0.93]) and PI between the eyes, PAPP-A multiple of median and uterine artery PI were determined to be the most important predictors of PE, which were subsequently integrated into a multiple regression model (sensitivity: 94% [95% CI, 0.70-1.00]; specificity: 93% [95% CI, 0.89-0.96]). CONCLUSION This study provided a screening method for individuals at higher risk of progressing to preeclampsia in the third trimester of pregnancy.
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Affiliation(s)
- Maasoumeh Saleh
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Naemi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Aghajanian
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Kamran Hessami
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mahmood Bakhtiyari
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Dai X, Kang L, Ge H. Doppler parameters of ophthalmic artery in women with preeclampsia: A meta-analysis. J Clin Hypertens (Greenwich) 2022; 25:5-12. [PMID: 36495167 PMCID: PMC9832230 DOI: 10.1111/jch.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Preeclampsia is a progressive and severe cardiovascular disorder in pregnant women. To determine the potential significance of ophthalmic Doppler parameters in preeclamptic women and to provide evidence-based hints for clinical practice and scientific investigation. We searched PubMed, Embase, Web of Science, and the Cochrane Library till July 31, 2022. Pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random effects model. Heterogeneity across included studies was evaluated utilizing the Q test and I2 statistic. We identified 8 observational studies that met the inclusion criteria. The pooled SMD for peak systolic velocities (PSV) was .12 (95% CI: -.82, 1.06, p = .8071; I2 = 94%, p < .0001). The overall SMD for time-averaged mean peak velocities (MV) was 1.79 (95% CI: .87, 2.71, p = .0001; I2 = 60%, p = .1152). Regarding the pulsatility index (PI), the pooled SMD was -2.05 (95% CI: -3.12, -.98, p = .0002; I2 = 92%, p < .0001). Overall SMD for end-diastolic velocities (EDV) was 1.11 (95% CI: .23, 1.98, p = .0136; I2 = 92%, p < .0001). The pooled SMDs for resistance index (RI) and peak ratio (PR) was -.18 (95% CI: -1.90, 1.53, p = .8333; I2 = 96%, p < .0001) and 1.46 (95% CI: -1.30, 4.22, p = .2994; I2 = 99%, p < .0001), respectively. Publication bias was not identified. MV, PI, and EDV showed significant differences between patients with preeclampsia and non-hypertensive pregnant participants. Studies on the predictive performance of ophthalmic artery Doppler parameters are warranted.
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Affiliation(s)
- Xinxin Dai
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Li Kang
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Huiyu Ge
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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