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Zatreanu L, Iyer NS. UNILATERAL CHEMOSIS, BULLOUS SEROUS RETINAL DETACHMENT, AND PRESUMED BACILLARY LAYER DETACHMENT IN SEVERE PREECLAMPSIA. Retin Cases Brief Rep 2023; 17:200-205. [PMID: 33731606 DOI: 10.1097/icb.0000000000001141] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To report a case of unilateral chemosis, serous retinal detachment (SRD), and presumed bacillary layer detachment in pregnancy. METHODS Clinical examination and multimodal imaging findings were reviewed and analyzed. RESULTS A 17-year-old female patient with severe preeclampsia was found to have unilateral chemosis and bullous SRD. Postpartum optical coherence tomography revealed thickened choroid and presumed bacillary layer detachment. Two weeks later, chemosis and SRD resolved, leaving behind mottled hyperpigmentation, drusen, and subretinal drusenoid deposits. CONCLUSION The combination of chemosis and SRD in preeclampsia is exceedingly, rare and it has never previously been reported to occur unilaterally. With delivery, visual acuity, chemosis, choroidal thickness, and SRD all normalize.
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Affiliation(s)
- Luca Zatreanu
- Department of Ophthalmology, Cooper University Hospital, Camden, New Jersey
- ReFocus Eye Health, Philadelphia, PA and Camden, New Jersey; and
| | - Neel S Iyer
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey
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Govindaraju VK, Schimmel OC, Trese MGJ, Garretson BR, Faia LJ. Bilateral Exudative Retinal Detachments, Chemosis, and Impaired Ocular Motility in the Setting of Preeclampsia and HELLP Syndrome. JOURNAL OF VITREORETINAL DISEASES 2022; 6:255-258. [PMID: 37008554 PMCID: PMC9976124 DOI: 10.1177/24741264221083402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: We present a complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome including bilateral exudative retinal detachments, bullous chemosis, and impaired ocular motility. Methods: The patient was followed in the inpatient and outpatient setting with clinical examinations, optical coherence tomography, widefield fundus photography, neuroimaging including magnetic resonance imaging of the brain/orbits, as well as carotid artery ultrasonography. Results: Our patient was admitted with bilateral vision changes in the setting of preeclampsia and HELLP syndrome and was found to have bilateral exudative detachments, retinal exudation, severe bullous chemosis, and impaired motility. She was started on intravenous dexamethasone followed by an extended prednisone taper with resolution of her ocular findings and return of her vision to baseline. Conclusions: There is evidence that HELLP syndrome and preeclampsia are proinflammatory syndromes. Aggressive blood pressure control, corticosteroids, and a multidisciplinary approach might accelerate visual and systemic recovery in these complex cases.
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Affiliation(s)
- Viren K. Govindaraju
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Olivia C. Schimmel
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Matthew G. J. Trese
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
- Associated Retinal Consultants, Oakland University William Beaumont Hospital, Royal Oak, MI, USA
| | - Bruce R. Garretson
- Associated Retinal Consultants, Oakland University William Beaumont Hospital, Royal Oak, MI, USA
| | - Lisa J. Faia
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
- Associated Retinal Consultants, Oakland University William Beaumont Hospital, Royal Oak, MI, USA
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Stern-Ascher CN, North VS, Garg A, Ananth CV, Wapner RJ, Bearelly S. Subfoveal Choroidal Thickness and Associated Changes of Angiogenic Factors in Women with Severe Preeclampsia. Am J Perinatol 2021; 38:482-489. [PMID: 31683325 PMCID: PMC10895649 DOI: 10.1055/s-0039-1698832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Severe preeclampsia complicates roughly 1% of all pregnancies. One defining feature of severe preeclampsia is new onset visual disturbance. The accessibility of the choroid to high-resolution, noninvasive imaging makes it a reasonable target of investigation for disease prediction, stratification, or monitoring in preeclampsia. This study aimed to compare subfoveal choroidal thickness between women with severe preeclampsia and those with normotensive pregnancies, and to investigate associations between such findings and other indicators of disease severity, including gestational age and serum angiogenic factors. STUDY DESIGN We designed a case-control study comprised of 36 women diagnosed with severe preeclampsia (cases) matched to 37 normotensive women (controls) by race/ethnicity and parity, all diagnosed in the postpartum period. All patients underwent enhanced depth imaging spectral-domain optical coherence tomography and serum analysis. RESULTS Cases showed no difference in subfoveal choroidal thickness compared with controls (p = 0.65). Amongst cases, subfoveal choroidal thickness and gestational age at delivery were inversely related (r = 0.86, p < .001). There was a positive association of placental growth factor with subfoveal choroidal thickness amongst cases (r = 0.54, p = 0.002). CONCLUSION This study suggests a relationship between the degree of disease severity and the magnitude of choroidal thickening. We also show an association between this index and placental growth factor level in the postpartum period.
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Affiliation(s)
- Conrad N Stern-Ascher
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Victoria S North
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Aakriti Garg
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Cande V Ananth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
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Gur Z, Buhbut O, Fagan X, Tsaban G, Levy J. Spectral-domain optical coherence tomography features in cases of pre-eclampsia and the relationship with systemic parameters. Can J Ophthalmol 2020; 55:524-526. [PMID: 32860745 DOI: 10.1016/j.jcjo.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Zvi Gur
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ortal Buhbut
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xavier Fagan
- Medical Retina Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Gal Tsaban
- Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Abstract
PURPOSE We report here, the morphological characteristics of the retina and choroid in a patient with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, who was not aware of her pregnancy before visiting our hospital. METHODS Case report. RESULTS The patient complained of visual disturbances in both eyes for a few days. Extensive serous retinal detachment and hyperreflective foci were observed in both eyes on spectral domain optical coherence tomography (SDOCT). Enhanced depth imaging technique using SDOCT revealed choroidal thickening and unclear choroidal vessel contour. Her blood pressure was 230/168 mmHg. Laboratory data showed hemolysis and liver dysfunction. Obstetrical examination disclosed her pregnancy. She was diagnosed as having HELLP syndrome. Because her general condition improved after prompt Cesarean delivery, the fundus lesions were rapidly resolved with choroidal thinning. CONCLUSION The eyes in a patient with HELLP syndrome showed characteristic choroidal morphology. The choroidal morphology shown with SDOCT might be one of the pathognomonic signs for a diagnosis of HELLP syndrome.
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Elschnig's Spots in the Acute and Remission Stages in Preeclampsia: Spectral-Domain Optical Coherence Tomographic Features. Eur J Ophthalmol 2015; 25:e84-7. [DOI: 10.5301/ejo.5000586] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/20/2022]
Abstract
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.
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Abstract
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.
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