Prevalence Of Retinal Changes Research Articles

Fundoscopic changes in preeclampsia and eclampsia and their association with fetal outcome

Abstract Introduction: Hypertensive disorder is a major cause of maternal and perinatal mortality and morbidity, with preeclampsia and eclampsia being the most common. Preeclampsia is characterized by endothelial dysfunction and vasospasm of vessels, which can be observed by an ocular fundus examination. The fundus usually develops changes such as hypertensive retinopathy, papilledema, exudative retinal detachment, and vitreous and preretinal hemorrhages. Retinopathy is associated with placental insufficiency and intrauterine growth retardation. Therefore, this study has been undertaken to assess the prevalence of retinal changes in preeclampsia and their association with fetal parameters. Objective: To study the fundus changes in preeclampsia. To study the relationship between fundus changes and fetal outcome with respect to various parameters like birth weight, APGAR score, stillbirth, and perinatal death. To study the relationship between fundus changes with respect to proteinuria and serum uric acid. Study Design: Observational study. Methodology: One hundred patients presenting to the department of obstetrics and gynecology diagnosed with preeclampsia at a tertiary care center were included in the study. The patient recruited underwent an ocular examination using Snellen’s chart, a pupillary examination, a slit lamp examination, and a dilated fundus examination. The retinopathy was graded according to Keith and Wagner’s classification. The fetal parameters considered were birth weight, APGAR score, stillbirth, and neonatal death. Results: Patients ages ranged from 25 to 30 years old, with an average of 23.28 ± 3.37. Average systolic and diastolic blood pressures were 156.9 ± 17.961 and 104.88 ± 13.58, respectively. All patients had normal anterior segments. Visual acuity was6/6 in most of the patients. Fundus changes were noted in 48% of patients. Based on retinopathy classification, we found 66.7% patients with Grade 1 and 27.1% patients with Grade 2 hypertensive retinopathy. Only 6.3% of patients presented with Grade 3 hypertensive retinopathy. There was a significant association between retinopathy and proteinuria (P = 0.003), serum uric acid (P = 0.002), and the fetal birth weight (P = 0.001). Conclusion: Our findings suggest that progressive fundal changes in preeclampsia indicate worsening of the pathophysiological status of pregnancy-induced hypertension (PIH) and help in management. The degree of hypertensive retinopathy in women with preeclampsia is a valid and reliable prognostic factor that serves as an indirect marker of the severity of PIH and fetal outcome. Fundus examination is a simple, noninvasive, and cost-effective procedure that could be the initial finding in an asymptomatic patient who may require immediate management, which may help in saving the lives of both the mother and the baby. Fundus evaluation is essential for all patients with PIH.

Pregnancy Induced Hypertension and Retinopathy

AIM AND OBJECTIVES: The aim of this study is to determine the prevalence of retinal changes in pregnancy induced hypertension and to find out its association with severity of hypertension and proteinuria. MATERIAL AND METHODS: A total of 94 pregnant females presented with pregnancy induced hypertension were included in this study. Patients with pre-existing hypertension, coexisting diabetes mellitus, severe anemia, connective tissue disorders were excluded from the study. Detailed fundus examination done and results were interpreted. OBSERVATION: Out of 94 patients with pregnancy induced hypertension, 41.5% belongs to 26-28 years of age.59.65 were primigravida. Headache was common complaint with 27.6% followed by blurred vision. Among the participants, 52.1% having systolic blood pressure of 150 to 159mmHg presented with fundus changes and 45.8% having diastolic pressure of more than 110mmHg presented fundus finding. In fundus finding, 51.0% presented with hypertensive retinopathy. Among hypertensive retinopathy, 43.8% cases were Grade I, 39.6% cases were Grade II, 12.5%cases were Grade III,4.1% cases were Grade IV.Grade I and Grade II found to be common. Our study shows statistically significant relationship with severity of hypertension and retinal changes (p<0.05) CONCLUSION: The study concluded that there is a positive correlation of fundus changes with severity of hypertension and grades of proteinuria. There is positive association with severity of hypertension, blood urea levels, serum uric acid level. So regular ophthalmic examination is mandatory in assessing the vascular changes in retina and helps in follow up the patients postpartum to prevent the complications. Keywords: Pregnancy induced hypertension, Hypertensive retinopathy, proteinuria..

A STUDY ON THE PREVALENCE OF FUNDUS CHANGES IN PREGNANCY INDUCED HYPERTENSION AMONG ANTENATAL CARE PATIENTS ATTENDING GMERS HOSPITAL, VALSAD

Purpose: It was to determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the Retinal changes and age, Gravida, Parity, Blood pressure, Proteinuria and Severity of the disease. Study design: Hospital based Cross sectional study. Materials & method: All the patients admitted with a diagnosis of PIH were included in this study. Age, Gravida, Parity, Blood pressure, and Proteinuria were noted from the case record. Fundus examination was done by Indirect Ophthalmolscopy. The finding were noted and were analysed using Microsoft Excel. Result: The mean age of patients was 23.48 years. Prevalence of fundus changes in PIH is 67%. Out of 88 patients, 41 (46.59%) were the primigravida. 3 (7.31%) patients had gestational hypertension, 17 (41.46%) patients had preeclampsia, and 21 (51.21%) had eclampsia. Hypertensive retinopathies were noted in 59 (67%) patients. Retinal detachment was seen in one patient and one patient with papilloedema. There was statistically significant positive association of retinal changes with proteinuria (p= 0.0001), and severity of the PIH (p= 0.004). Conclusions: Retinal changes were seen in 67% of patients with PIH. Better antenatal care and early detection and treatment of PIH cases is needful so that there will be decrease in the chances of developing retinopathy.

Fundoscopic Findings in Pregnancy Related Hypertensive Disorders and Its Association with Maternal and Fetal Outcomes

Objectives: To determine the prevalence of retinal changes in pregnancy-related hypertensive disorders and their association with maternal and fetal outcomes. Introduction: There is a grave risk to both mother and child when hypertensive problems complicate pregnancy. However, hypertensive sort of disorders during pregnancy have been allied to poor maternal and also neonatal outcomes. This research aimed to evaluate effects of hypertensive sort of disorders of pregnancy on both mothers and their unborn children by analyzing the prevalence, causes, and treatment of these conditions. Subjects and methods: BBH Rawalpindi, Inpatient Department of Gynecology and Obstetrics conducted the case-control research during the period from January 2021 to June 2021. In all, 149 patients participated in the research. Because seven patients could not be located, 142 cases were analyzed. Mild class preeclampsia (65.0 instances), severe class preeclampsia (32.0 hot cases), and also eclampsia (one case) were the subcategories used to categorize patients further, according to research. Thirty-one women who were not hypertensive throughout pregnancy were enlisted as controls. Results: Ninety percent of cases manifested with some edema. About a quarter basically patients had proteinuria above 300.0 mg/24 hours (26.76%), nearly half had proteinuria over two g/24 hours (47.18%), and about a quarter had urine protein based excretion of 3.0-5.0 g/24 hours (25.35%). Usually, incidence of specially HELLP (normally hemolysis, increased liver based special enzymes, and also squat platelet tot up) set of symptoms was 2.80%, raised bilirubin levels were seen in 47%, illustration symptoms occurred in 6.4%, vaginal based hemorrhage occurred in 11.30%, in addition to 42.2% of cases involved the central nervous system. It was shown that eclampsia was the cause of mortality in 2.8% of all maternal deaths. 16.9 percent of births were stillbirths, while 4.23 percent of newborns died. Conclusion: Compared to pregnant women with normal blood pressure, those who suffer from hypertensive disorders of pregnancy have a higher risk of having a baby born with complications. Our research did find a declining trend, although it was less than those seen in other studies; this may be because more of our study's births occurred in hospitals. Keywords: Neonatal outcome, maternal outcome, acute renal failure, and the HELLP syndrome

Prevalence of retinal changes in patients with systemic sclerosis: the association between retinal vascular changes and nailfold capillaroscopic findings.

BackgroundSystemic sclerosis (SSc) is a connective tissue disease affecting the skin and multiple organs. Most of the evidence on ocular involvement comes from small studies. We evaluated the retinal vascular changes in patients with SSc and its associations with types, disease duration, skin score, and nailfold capillaroscopy changes.Material and methodsWe evaluated the demographic, clinical and nailfold capillaroscopy data of 52 patients referring to the clinic of scleroderma with SSc according to the 2013 ACR/EULAR SSc criteria. In addition, full ophthalmic examination in 52 patients and fundus photography in 40 patients were done in the ophthalmology clinic.ResultsThere were 52 (49 women and 3 men, 17 diffuse and 35 limited) patients with SSc with mean disease duration of 8 ±5 years and mean age of 40 ±9 years. Retinal changes in the ophthalmologic examination were seen in 30.7% as increased vascular tortuosity. None of the patients had cotton wool spot, hemorrhage or hard exudate. Forty patients underwent fundus photography and 22.5% of them had vascular tortuosity. Only the presence of hemorrhage in the nailfolds was correlated with retinal tortuosity, and the other characteristics of nailfold capillaroscopy did not have any association with retinal changes.ConclusionsRetinal vascular changes were seen in about one third of our patients. There was no correlation between nailfold capillaroscopy, disease duration, type and skin score of SSc patients and retinal vascular changes. These findings suggest that the mechanisms or the quality of changes in the retinal vessels and nailfold vasculature may be different.

RETINAL CHANGES IN PREGNANCY INDUCED-HYPERTENSION

Objective: The aim is to determine the prevalence of retinal changes in Pregnancy Induced Hypertension (PIH) and its association with age, parity, proteinuria, blood pressureand severity of PIH.
 Methods: This is a tertiary hospital based Cross-Sectional study including all patients, clinically diagnosed with Pregnancy Induced Hypertension. General demographic details along with age, gravida, gestation period, proteinuria, blood pressure and severity of PIH were noted. Ophthalmic examination was performed and detailed fundus examination was done.
 Results: A total of 52 patients were included in this study. Their mean age was 24.9 y; 32 out of 52 patients were primigravida (61%) and 20 patients were multi gravida (39%). Out of 52 patients 34 (65.38%) had Gestational Hypertension, 16 (30.76%) had preeclampsia, and 2 (3.8%) had eclampsia. 3 (5.76%) out of 29 patients with BP<160/100 mmHg and 10 (19.23%) out of 23 patients with BP>160/100 mmHg had developed Hypertensive Retinopathy. Hypertensive Retinopathy was seen in 13 (25%). Proteinuria was seen in 10 (19.23%) patients ranging between+to+++on the dipstick.
 Conclusion: Statistically significant correlation between retinal changes and proteinuria, blood pressure and severity of Disease.The most important requisite in a case of Pregnancy Induced Hypertension is Fundoscopic examination of retina. The retinal vessels during PIH form a gateway to visualize changes in the body and placental vessels, and may play a key role in early detection and treatment of PIH for protection of the mother as well as the fetus.

Retinal changes in pregnancy-induced hypertension

Aims: The aim was to determine the prevalence of retinal changes in pregnancy-induced hypertension (PIH) and any association between the retinal changes and age, parity, blood pressure, proteinuria, and severity of the disease. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: All the patients admitted with a diagnosis of PIH were included in this study. Age, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. Fundus examination was done with a direct ophthalmoscope. The findings were noted and were analyzed using SPSS program. Results: A total of 150 patients of PIH were examined. The mean age of patients was 25.1 years. The gestation period ranged from 27 weeks to 42 weeks; 76 (50.67%) were the primi gravida. 92 (61.33%) patients had gestational hypertension, 49 (32.67%) patients had preeclampsia, and 9 (6%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 18 (12%) patients - Grade 1 in 12 (8%) and Grade 2 in 6 (4%). Hemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P = 0.037), proteinuria (P = 0.0005), and severity of the PIH (P = 0.004). Conclusions: Retinal changes were seen in 12% of patients with PIH. Occurrence of hypertensive retinopathy in PIH cases has been decreased due to better antenatal care and early detection and treatment of PIH cases. There is a greater chance of developing retinopathy with increase in blood pressure, severity of PIH, and proteinuria in cases of PIH.

Fundus changes in pregnancy induced hypertension

AIM To determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and blood pressure, proteinuria, and severity of the disease.

High prevalence of retinal vascular changes in never‐treated essential hypertensives: an inter‐ and intra‐observer reproducibility study with non‐mydriatic retinography

Background: The clinical significance of stratifying cardiovascular risk in hypertensive patients on the basis of retinal changes such as arteriolar narrowing or arterio‐venous crossing has been criticized. Aim: Objectives of the study were: (i) to compare the prevalence of retinal abnormalities detected by non‐mydriatic retinography with that of other quantitative markers of target organ damage (TOD), such as echocardiographically determined left ventricular hypertrophy (LVH), carotid structural abnormalities and microalbuminuria in recently diagnosed and never treated hypertensives; (ii) to assess the inter‐ and intra‐observer reproducibility in evaluating retinal microvascular changes. Methods: One hundred ninety‐seven grade 1 (73%) and grade 2 essential hypertensives (119 males; mean age 46.8 ± 12.0 years, duration of hypertension: 2.3 ± 1.8 years) referred for the first time to our outpatient hypertension hospital clinic were subjected to the following procedures: (i) repeated clinic blood pressure (BP) measurements; (ii) electrocardiogram; (iii) routine blood chemistry and urinalysis; (iv) 24‐h urine collection for microalbuminuria; (v) 24‐h ambulatory BP monitoring; (vi) non‐mydriatic retinography; (vii) echocardiogram; (viii) carotid ultrasonography. Retinal changes were evaluated according to a modified Keith, Wagener and Barker (KWB) classification by two physicians, who had no knowledge of the patients' characteristics. These following markers of TOD were considered: (i) left ventricular mass index ≥125 g/m2in men and ≥110 g/m2in women; (ii) at least one carotid plaque (focal thickening >1.3 mm) or diffuse common carotid thickening (≥0.9 mm); (iii) microalbuminuria (urinary albumin excretion ≥30 and <300 mg/24 h). Results: The prevalence rates of LVH, carotid structural alterations and microalbuminuria were 12.9, 26.0 and 8.6% respectively; while the distribution of patients in the different degrees of hypertensive retinopathy made by two independent readers (1 and 2) was: 0 = 15.2, I = 25.4, II = 58.9, III = 0.5% (1); 0 = 14.7, I = 27.9, II = 56.8, III = 0.5% (2), p = NS. The overall prevalence of retinal changes was 84.3% and 84.7%, respectively, and the inter‐ and intra‐observer reproducibility 89.1, 91.6 (1) and 90.2% (2), respectively. Conclusions: Our data indicate that: (i) the prevalence of initial retinal changes is far higher than that of other prognostically validated quantitative markers of cardiac and extracardiac TOD; (ii) the inter‐ and intra‐observer reproducibility between two skilled readers in detecting these abnormalities with non‐mydriatic retinography is excellent; (iii) the high prevalence of retinal changes in untreated subjects with mild hypertension offers a new piece of evidence that they cannot be considered a proof of TOD.

Retinopathy in acute leukaemia at initial diagnosis: correlation of fundus lesions and haematological parameters.

To determine the prevalence of retinal changes in newly diagnosed acute leukaemia patients, and to establish the relationship between retinal lesions and haematological parameters in these patients. A total of 127 patients with acute leukaemia (myeloid and lymphoid), of both genders, aged between 13 and 77 years, were examined by an ophthalmologist for retinal changes using direct/indirect ophthalmoscopy within 2 days of diagnosis before starting chemotherapy. Retinal lesions were seen in 62 cases (49%), with intraretinal haemorrhages being the most common lesion (42%). A high white blood cell count was significantly associated with intraretinal haemorrhages (p = 0.04) and white-centred haemorrhages (p = 0.001), while a low platelet count was significantly associated with intraretinal haemorrhages (p = 0.03) in acute myeloid leukaemia patients. A high white blood cell count may be considered as important as a low platelet count in the pathogenesis of leukaemic retinopathy.

Left ventricular concentric remodelling and extracardiac target organ damage in essential hypertension.

Left ventricular (LV) concentric remodelling is an adaptive change in cardiac geometry frequently observed in arterial hypertension. This study was addressed to investigate the extent of extracardiac target organ damage (TOD) in patients with LV concentric remodelling. Two groups of never-treated essential hypertensives, 31 with normal LV geometry (group I, relative wall thickness: 0.39) and 31 with LV concentric remodelling (group II, relative wall thickness: 0.47) matched for age, sex, body mass index and mean 24-h systolic blood pressure (BP), were included in the study. They underwent clinical and laboratory examination, 24-h ambulatory BP monitoring (ABPM), 24-h urinary collection for microalbuminuria, non-mydriatic photography of ocular fundi, echocardiography and carotid ultrasonography. In both groups age (I: 51 +/- 11 years; II: 51 +/- 11 years), body mass index (I: 25 +/- 3 kg/m(2); II: 26 +/- 3 kg/m(2)), clinic and 24-h ABPM values (I: 149 +/- 11/95 +/- 8, 142 +/- 11/91 +/- 7 mm Hg; II: 150 +/- 11/98 +/- 9, 142 +/- 12/92 +/- 9 mm Hg) were similar by design. There were no differences between patients with normal LV geometry and with LV concentric remodelling in LVM index (97 +/- 16 vs 99 +/- 16), carotid intima-media thickness (0.7 +/- 0.02 vs 0.7 +/- 0.02) and carotid plaques prevalence (35% vs 35%). Furthermore, no significant differences among the two groups were found in the prevalence of retinal changes and microalbuminuria. These results suggest that in hypertensive patients with similar BP and LVMI levels, LV concentric remodelling is not associated with more prominent TOD.

Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients.

To evaluate in a selected population of patients with a recent diagnosis of hypertension whether a reduced nocturnal fall in blood pressure, confirmed by two 24 h ambulatory blood pressure monitoring (ABPM) sessions is associated with more prominent target organ damage (TOD). The study was structured in two phases: in the first, 141 consecutive, recently diagnosed, never-treated essential hypertensives underwent 24 h ABPM twice within 3 weeks; in the second phase, 118 of these patients showing reproducible dipping or non-dipping patterns underwent the following procedures: (1) routine blood chemistry, (2) 24 h urinary collection for microalbuminuria, (3) amydriatic photography of ocular fundi, (4) echocardiography and (5) carotid ultrasonography. The 92 patients with (>10%) night-time fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (dippers) in both monitoring sessions were similar for age, gender, body surface area, smoking habit, clinic BP, 24 h and 48 h BP to the 26 patients with a < or = 10% nocturnal fall (non-dippers) in both sessions. The prevalence of left ventricular hypertrophy (LVH) (defined by two criteria: (1) LV mass index > or = 125 g/m2 in both genders; (2) LV mass index > or = 120 and 100 g/m2 in men and women, respectively) and that of carotid intima-media (IM) thickening (IM thickness > or = 0.8 mm) were significantly higher in non-dippers than in dippers (23 versus 5%, P < 0.01; 50 versus 22%, P < 0.05; and 38 versus 18%, P < 0.05, respectively). There were no differences among the two groups in the prevalence of retinal changes and microalbuminuria. The strength of the association of LV mass index with night-time BP was slightly but significantly greater than that with daytime BP. This study suggests that a blunted reduction in nocturnal BP, persisting over time, may play a pivotal role in the development of some expressions of TOD, such as LVH and IM thickening, during the early phase of essential hypertension, despite similar clinic BP, 24 h and 48 h BP levels observed in non-dippers and dippers.