Detachment In Preeclampsia Research Articles

THE OPTICAL COHERENCE TOMOGRAPHY (OCT) IN A PATIENT WITH RETINOPATHY-ASSOCIATED ECLAMPSIA: WHAT TO EXPECT?

Introduction : Eclampsia is a common pregnancy complication, that has been associated with retinopathy. Screening of retinopathy in preeclampsia/eclampsia is essential for early detection and management. Various imaging modalities are used to diagnose retinopathy. However, because of the higher-resolution imaging demand, optical coherence tomography (OCT) suggests a better option. The present study aimed to report the OCT findings of retinopathy-associated eclampsia.
 Case Illustration : A 24-year-old pregnant woman in 27th-week gestation with eclampsia presented the new onset of bilateral sudden diminution of vision. The vision in her right eye was limited to hand movement and that in her left eye was light perception only. Clinical examination revealed Siegrist streaks, Elschnig spots, and flame shape hemorrhages. OCT of both eyes demonstrated subretinal fluid, intraretinal fluid, thickening of the retinal layer, also inner retinal hyperreflectivity. Two months after the follow-up, there was an improvement in the OCT findings and also in the visual acuity.
 Discussion : An increase in macular thickness could be a characteristic feature in the OCT of retinopathy- associated eclampsia caused by retinal arteriolar narrowing due to systemic hypertension and ischemia. Previous studies have demonstrated subretinal/intraretinal fluid with or without serous retinal detachment in preeclampsia. Following our case, we report subretinal fluid, intraretinal fluid in the outer plexiform layer with retinal detachment and macular edema. The subretinal fluid and serous detachment were most likely caused by the changes in the fluid and ion-transport function of the retinal pigment epithelium (RPE).
 Conclusion : OCT can provide valuable information for diagnosis and follow-up retinopathy in preeclampsia/eclampsia.

Serous Retinal Detachment in Pre-Eclampsia: A Systematic Review of Case Report

Serous Retinal Detachment is one of the preeclampsia complications which may be identified during the third trimester of pregnancy or postpartum period that may be related to pregnancy condition. We review case reports related to serous retinal detachment in preeclamptic patients from online databases such as MEDLINE/Pubmed and Science Direct from 2011 to 2021 in accordance with PRISMA guidelines. Authors independently screened abstracts of articles retrieved articles that were considered potentially relevant, and extracted the articles obtained. From 17 articles, serous retinal detachment is higher in severe preeclampsia and HELLP syndrome (88%). Most patients were indicated to do caesarean section (71%) as their mode of delivery due to managing severe preeclampsia. Although most patients (94%) reported retinal detachment involving the macular area, complete resolution was observed in all the patients (94%). Early detection of serous retinal detachment may increase awareness of early detection of severe preeclampsia and HELLP syndrome.

"Hypertensive Chorioretinopathy and Serous Retinal Detachment in PreEclampsia"

"Hypertensive Chorioretinopathy and Serous Retinal Detachment in PreEclampsia"

Serous retinal detachment in preeclampsia and malignant hypertension

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. 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. 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). 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.

Bilateral serous retinal detachment complicating preeclampsia

Abstract Preeclampsia is an obstetric complication that affects approximately 5% of pregnant women. The visual system may be affected with variable manifestations and variable intensity. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis may be related to the choroidal ischemia secondary to arteriolar vasospasm. We report a case of 36-year-old woman who developed severe preeclampsia in her first pregnancy with blurred vision secondary to bilateral serous retinal detachment.

Bilateral Serous Retinal Detachment in Preeclampsia: Case Report

Abstract Introduction. Preeclampsia presents a medical condition in pregnancy that is manifested with increased blood pressure and protein urine. Ocular involvement is rare. Retinal detachment in preeclampsia is a rare complication; it only occurs in 1-2% of severe preeclampsia but in 10% of those with eclamptic seizures. Case report. A pregnant patient G1P0 visited the outpatient clinic of the University Clinic for Ophthalmology complaining on visual disturbances. The chief complaint was blurred vision and headaches. She was in 31 week of gestation and complained that she had increased blood pressure over the last month. After initial assessment she was suspected of central serous retinal ablation (CSCR). Ocular ultrasound and posterior segment OCT (optical coherence tomography) confirmed the diagnosis. Treatment and outcome. Obstetric examination confirmed high blood (TA180/130) pressure with dipstick urine showing(+++). Unfortunately, the ultrasound showed an eutrophic pregnancy in 31 g.w. with fetus mortus inutero. The patient was administered to the intensive care unit. She had an ophthalmologic check-upat 2 weeks and one month post-partum that showed regression and visual acuity was getting better. The final check-up after 6 months revealed that retina was in place with no subretinal substantial fluid and no macular edema. Conclusion. Serous retinal detachment is a rare complication of preeclampsia. In most case it resolves spontaneously few weeks post delivery.

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

Preeclampsia is characterized by hypertension, proteinuria, and edema occurring in the second half of pregnancy. The main ocular manifestations are related to dysfunction of both retinal and choroidal circulation [1, 2]. Similarly to hypertensive retinopathy, cotton wool spots, hemorrhages, edema, papilloedema, serous retinal detachment and lesions of the retinal pigment epithelium (RPE) may develop in preeclampsia. Fluorescein angiography shows areas of choroidal hypoand nonperfusion (Elschnig spots) in preeclamptic women with serous retinal detachment [3, 4]. It has been proposed that intense spasm of the choroidal arterioles may be responsible for choroidal ischemia, resulting in increased vascular permeability, and subsequently, accumulation of serous fluid in the subretinal space [4]. We investigate the changes in the outer retina and choroid by means of enhanced depth imaging (EDI) [5] spectral-domain optical coherence tomography (SD-OCT) in a preeclamptic women with serous retinal detachment. A 38-year-old woman developed hypertension (190/ 110 mmHg), proteinuria, and generalized edema in the 35th week of pregnancy. Two days after undergoing a cesarean section, the patient was referred to our department for impairment of vision in both eyes. Best-corrected visual acuity was 20/25 in the right eye (RE) and 20/80 in the left eye (LE). Fundus biomicroscopy showed a peripapillary serous retinal detachment bilaterally, with involvement of the LE macula. Blue fundus autofluorescence (b-FAF) showed inhomogeneous increased autofluorescence in the peripapillary area, while near-infrared fundus autofluorescence (nirFAF) revealed peripapillary areas of hypoautofluorescence together with focal points of intensely decreased nir-FAF (Fig. 1). EDI SD-OCT scans through the areas of abnormal autofluorescence and the macula showed peripapillary serous retinal detachment bilaterally with focal RPE elevations, and serous macular detachment in the LE (Fig. 2). Choroidal thickness in the scan passing through the macula was 475 lm RE, 361 lm LE subfoveally, and 263 lm RE, 367 lm LE in the peripapillary area (Fig. 2) (increased compared with reference values) [5]. Two weeks later, BCVA improved to 20/20 in both eyes, and fundus biomicroscopy revealed disappearance of serous retinal detachment. b-FAF still showed increased autofluorescence in the peripapillary area, while nir-FAF revealed almost complete disappearance of both peripapillary areas of hypoautofluorescence and focal points of decreased nir-FAF (Fig. 1). EDI SD-OCT scans confirmed the disappearance of serous retinal detachment in both eyes, and showed persistence of focal RPE elevations (Fig. 2). Choroidal thickness in the scan passing through the macula was unchanged subfoveally, while decreased to 186 lm RE, 284 lm LE in the peripapillary area (Fig. 2). Previous reports have documented, by time domain OCT, the presence of serous retinal detachment in preeclamptic women [6]. To the best of our knowledge this is the first case study to describe the SD-OCT features of serous retinal detachment in preeclampsia. SD-OCT revealed focal RPE elevations in the peripapillary areas of abnormal FAF (both b-FAF and nir-FAF) suggesting compromised fluid transport (choroid-RPE-retina) in the acute phase of the disease, which persisted also after the resolution of both serous retinal detachment and focal L. Querques G. Querques (&) F. Loperfido R. Lattanzio F. Bandello Department of Ophthalmology, University Vita Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy e-mail: giuseppe.querques@hotmail.it

Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy: complications and management.

We report the management of a young woman with preeclampsia of pregnancy who developed bilateral Purtscher-like retinopathy and serous retinal detachment subsequently complicated by macular hole and tractional retinal detachment. The best-corrected visual acuity was 20/1000 bilaterally. Fundus examination showed a picture of Purtscher-like retinopathy bilaterally and a macular hole in the right eye. Fluorescein angiography showed areas of capillary dropout and Elschnig spots bilaterally. Optical coherence tomography confirmed the macular hole in the right eye and a shallow serous retinal detachment bilaterally. Systemic and laboratory workup was unremarkable. Triamcinolone acetonide (4 mg/0.1 mL) was injected intravitreally in the left eye; vitrectomy was advised for the right eye. However, when the patient returned after 4 months, the right eye had developed a macular tractional retinal detachment. Vitrectomy, membrane peeling, and gas tamponade were performed. When the patient returned 4 months after the intravitreal injection in the left eye, best-corrected visual acuity had improved to 20/40 with complete resolution of serous retinal detachment in that eye. Best-corrected visual acuity in the right eye remained at 20/1000 but with anatomic deterioration. One month after vitrectomy for the macular hole and tractional retinal detachment in the right eye, best-corrected visual acuity improved to 20/240 with normalizing foveal contours. Status quo was observed in both eyes for the next 8 months. Final best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. An unusual combination of Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy and its complication-macular hole with tractional retinal detachment-were managed by surgery and pharmacotherapy.