Choroidal and Retinal Thickening in Severe Preeclampsia

Abstract

PURPOSE.To compare choroidal thickness and retinal macular volume (RMV) among three groups of women: severe preeclampsia postpartum, normotensive postpartum, and normotensive nongravid. While visual disturbances often accompany severe preeclampsia, the underlying choroidal and retinal changes responsible for these symptoms have not been described.METHODS. This case-control study was based on 15 severe preeclampsia cases and 15 ethnicityand parity-matched normotensive controls recruited during the postpartum hospital stay. A reference group of 19 age-matched, nongravid, normotensive women was also studied. Choroidal thickness and RMV were measured by using enhanced depth imaging spectraldomain optical coherence tomography. Two retinal specialists, one of whom was masked to the case-control status, reviewed all images.RESULTS. Severe preeclampsia cases demonstrated greater mean choroidal thickness (425 6 90 lm vs. 354 6 140 lm; P ¼ 0.021) and RMV (9.0 6 0.4 mm 3 vs. 8.7 6 0.5 mm 3 ; P ¼ 0.006) than controls. In contrast, control and reference groups were similar with respect to choroidal thickness (354 6 140 lm vs. 363 6 82 lm; P ¼ 0.764) and RMV (8.7 6 0.5 mm 3 vs. 8.8 6 0.4 mm 3 ; P ¼ 0.870). Follow-up imaging of two severe preeclampsia cases within 3 months of delivery revealed decreasing choroidal thickness.CONCLUSIONS. Our results demonstrate subclinical retinal and choroidal thickening in the setting of severe preeclampsia. This is the likely source of its associated visual phenomena and may reflect rising levels of vascular endothelial growth factor. Retinal and choroidal markers could serve as novel predictive markers of severe preeclampsia.

Comparison of Choroidal Thickness in Preeclamptic, Healthy Pregnant, and Nonpregnant Women: A Systematic Review and Meta-Analysis

“…Four studies [21-23, 32] with a total of 194 participants (82 preeclamptic patients and 112 healthy nonpregnant women) were included. As shown in Figure 5, the CT of preeclampsia (μm, WMD = 54.30, 95% CI: –13.40 to 122.01) was not significantly different from the nonpregnancy group (Test of WMD = 0: z = 1.57, p = 0.116).…”

Retinal detachment in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome: Color vision abnormality as the first and predominant manifestation

“…This leak sometimes accumulates behind the retina, and retinal detachment occurs. This general concept may still be valid: pre‐eclamptic patients had thicker choroidal and retinal layers . Some other studies suggested a more delicate pathophysiological mechanism: choroidal vessel abnormality may cause HDP‐related retinal detachment.…”

“…This general concept may still be valid: pre-eclamptic patients had thicker choroidal and retinal layers. 11 Some other studies suggested a more delicate pathophysiological mechanism: choroidal vessel abnormality may cause HDP-related retinal detachment. This may be particularly true of retinal detachment in patients with HELLP syndrome.…”

Association between ophthalmoscopic changes and obstetric outcomes in pre-eclampsia and eclampsia

“…17 Therefore; retinal and choroidal markers could serve as novel predictive markers of severe preeclampsia. This further establishes the need of routine ophthalmoscopic examinations in all preeclamptic mothers irrespective of visual complaints.…”