Subfoveal Choroidal Thickness and Associated Changes of Angiogenic Factors in Women with Severe Preeclampsia

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.

Relationship between proteinuria and optical coherence tomographic features of the chorioretina in patients with pre-eclampsia

“…It was demonstrated that the choroid was responsive to circulating angiogenic factors, such as soluble endoglin (sEng), placental growth factor (PlGF) and VEGF [ 23 , 24 ]. Stern-Ascher et al [ 8 ] found a positive association of PlGF with central CT in severe pre-eclampsia, suggesting that intravascular inflammation and vasoconstriction caused by pre-eclampsia does affect CT. In the study comparing CT among three groups of normotensive non-gravid, normotensive postpartum and pre-eclampsia postpartum women using EDI OCT, Garg et al [ 9 ] reported that pre-eclampsia postpartum cases had greater CT and retinal macular volume than normotensive postpartum without difference of these values between normotensive postpartum and normotensive non-gravid women and suggested that it was due to higher serum-VEGF concentration in pre-eclampsia patients than normotensive pregnant women, which was reported by Celik at al.…”

“…High vascular density (VD) and fenestrated capillaries of the choroid make it sensitive to systemic changes. An imbalance of circulating anti-angiogenic factors including soluble fms-like tyrosine kinase 1 (sFLT1) and angiogenic factors such as vascular endothelial growth factor (VEGF) plays a role in endothelial dysfunction in patients with pre-eclampsia, which in turn influences ocular environment, especially choroid [8][9][10].…”

“…The spot (random) urine protein–creatinine ratio (normal range PCR, <0.3 mg/mg) was considered an alternative, quick and reliable method to assess quantitative proteinuria [ 16 ]. The relationship between serologic and haemodynamic changes of patients with pre-eclampsia and ocular characteristics has been focused by many researchers, but it has not been thoroughly elucidated yet [ 8 , 17 ]. Studies on the correlation of proteinuria and ocular changes in patients with pre-eclampsia are insufficient.…”

Plane-Wave Ultrasound Doppler of the Eye in Preeclampsia

“…30 This is supported by our prior OCT observation of increased retinal and choroidal thickness in certain subsets of PE. 31 , 32 We hypothesized that that this subclinical edema might originate from changes in the Vascular Endothelial Growth Factor (VEGF)-sensitive choriocapillaris. 33 In the present study, we observed reduced resistance in the choroid.…”

Relationship between the sFlt-1/PlGF ratio and the optical coherence tomographic features of chorioretina in patients with preeclampsia

“…Moreover, OCT angiography (OCT-A) can provide detailed imaging of the vascular structures of the retina and choroid repeatedly and noninvasively. Using this OCT technology, researchers have studied the correlation between maternal serologic changes in preeclampsia and ocular characteristics [ 16 , 17 ]. However, to our knowledge, no research on the relationship between the sFlt-1/PlGF ratio and ocular structural changes has been reported to date.…”