Pre-eclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or end-organ dysfunction in the last half of pregnancy.
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The prevalence of retinal involvement may vary according to the severity of pre-eclampsia.2
The correlation between systemic features and retinal morbidity in pre-eclamptic women is still controversial.2
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To the best of our knowledge, there is lack of data regarding the correlation between other systemic features and retinal morbidity.We retrospectively reviewed 10 visually symptomatic pre-eclamptic women who underwent complete ophthalmic examination and were found to have an abnormal spectral-domain optical coherence tomography (SD-OCT) finding between 2012 and 2017. Pre-eclampsia was diagnosed by The American College of Obstetricians and Gynecologists criteria. One patient developed HELLP syndrome.
All 10 women underwent a complete ophthalmoscopic examination, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, and Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). Features on SD-OCT evaluated included central subfield thickness (CST, defined as the average thickness of the macula in the central 1 mm Early Treatment Diabetic Retinopathy Study (ETDRS) grid), presence of subretinal (SRF)/intraretinal fluid (IRF), ellipsoid zone (EZ) integrity at the fovea (normal/abnormal), presence of EZ irregularities
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(EZ band without smooth appearance), peripapillary subretinal fluid, Elschnig spots (focal elevations of a thick highly reflective band of retinal pigment epithelium on SD-OCT),3
and intraretinal hyper-reflective dots within SRF Figure 1.6
Systemic parameters were also evaluated, including age, gestational age, diastolic and systolic blood pressures, presence of proteinuria, platelets count, and liver function (aspartate transaminase/alanine transaminase [AST/ALT]). The study adhered to the tenets of the Declaration of Helsinki and was approved by the local ethics committee. No informed consent was needed.
Fig. 1Spectral-domain optical coherence tomography findings in pre-eclamptic women. First row: subretinal fluid (*). Second row: subretinal fluid (*), disruption of ellipsoid zone (arrow), and intraretinal fluid (x). Third row: peripapillary subretinal fluid (white arrowhead). Fourth row: intraretinal hyper-reflective dots (long arrow) within subretinal fluid. Last row: Elschnig spot (black arrowhead).
Twenty eyes of 10 pre-eclamptic women were included in the study. Baseline characteristics and laboratory findings are presented in Table 1. At presentation, the mean ± SD BCVA was 0.6 ± 0.15 logMAR (20/80 Snellen equivalent). SD-OCT showed bilateral eye involvement in 100% of the women in an asymmetrical pattern. Peripapillary subretinal fluid was seen in 80% of the women in our study, 60% have shown abnormal EZ integrity at the fovea, and up to 40% had intraretinal hyper-reflective dots. Table 2 shows Spearman correlation test between other SD-OCT features to systemic and laboratory findings. We found negative correlation between mean diastolic and systolic blood pressure and the level of proteinuria to EZ integrity at fovea (i.e., the higher the blood pressure and proteinuria level, the more likely of identifying EZ abnormalities). Strong positive correlation was also noticed between the amount of intraretinal fluid to the rise of AST/ALT and platelets level, respectively. After correction for multiple tests, in exception of the correlation between AST/ALT and IRF, none of the above remained statistically significant.
Table 1Baseline characteristics and laboratory findings (n = 10).
| Variable | Range value | (mean ± SD) |
|---|---|---|
| Patients age, years | 20−36 | 26.1 ± 0.6 |
| Gestational age, days | 207−254 | 235 ± 20.3 |
| Delivery age, days | 221−281 | 253.7 ± 31.6 |
| Birth weight, g | 1250−2800 | 2155.9 ± 609.03 |
| Diastolic blood pressure, mm Hg | 76−149 | 101.2 ± 25.5 |
| Systolic blood pressure, mm Hg | 127−224 | 163.2 ± 33.4 |
| Urine protein, g | 1−4.1 | 2.3 ± 1.2 |
| Hemoglobin, g/dL | 7.8−13.3 | 10.4 ± 1.6 |
| Platelets, μL | 58−338 | 152.7 ± 88.6 |
| Creatinine, mg/dL | 0.45−1.02 | 0.75 ± 0.17 |
Table 2Spearman correlation between spectral-domain optical coherence tomography features and other clinical and systemic parameters (n = 10)
| SD-OCT features | Diastolic BP | Systolic BP | Urine protein | Hemoglobin | Creatinine | Elevated AST/ALT | Platelets |
|---|---|---|---|---|---|---|---|
| Central subfoveal thickness | −0.55 (p = 0.89) | −0.42 (p = 0.23) | −0.20 (p = 0.59) | −0.59 (p = 0.09) | −0.32 (p = 0.35) | 0.14 (p = 0.69) | −0.55 (p = 0.123) |
| Subretinal fluid | 0.26 (p = 0.43) | 0.41 (p = 0.20) | 0.50 (p = 0.14) | 0.61 (p = 0.06) | 0.33 (p = 0.31) | 0.04 (p = 0.9) | 0.69 (p = 0.25) |
| Intraretinal fluid | −0.48 (p = 0.13) | −0.48 (p = 0.13) | −0.18 (p = 0.60) | −0.57 (p = 0.55) | 0.15 (p = 0.60) | 0.82 (p = 0.002) | −0.85 (p = 0.02) |
| Peripapillary subretinal fluid | 0.98 (p = 0.77) | −0.97 (p = 0.77) | 0.15 (p = 0.66) | 0.33 (p = 0.34) | −0.51 (p = 0.10) | −0.26 (p = 0.43) | 0.26 (p = 0.45) |
| RPE elevations | −0.22 (p = 0.50) | −0.39 (p = 0.23) | 0.13 (p = 0.70) | 0.33 (p = 0.39) | −0.647 (p = 0.3) | 0.14 (p = 0.66) | 0.30 (p = 0.99) |
| Intraretinal hyper-reflective dots | 0.33 (p = 0.31) | 0.32 (p = 0.30) | 0.48 (p = 0.15) | −0.10 (p = 0.79) | −0.24 (p = 0.48) | 0.069 (p = 0.80) | 0.16 (p = 0.76) |
| Elschnig spots | −0.22 (p = 0.5) | −0.38 (p = 0.91) | −0.36 (p = 0.29) | −0.17 (p = 0.62) | 0.75 (p = 0.82) | −0.43 (p = 0.18) | 0.17 (p = 0.62) |
| EZ irregularity | 0.05 (p = 0.88) | 0.12 (p = 0.70) | 0.30 (p = 0.30) | 0.51− (p = 0.12) | −0.16 (p = 0.62) | 0.32 (p = 0.23) | −0.14 (p = 0.71) |
| EZ integrity at fovea | −0.72 (p = 0.01) | −0.79 (p = 0.03) | 0.64− (p = 0.04) | 0.50 (p = 0.14) | 0.34 (p = 0.33) | 0.34 (p = 0.3) | 0.34 (p = 0.35) |
BP, blood pressure; AST/ALT, aspartate transaminase/alanine transaminase; EZ, ellipsoid zone; RPE, retinal pigment epithelium; SD-OCT, spectral-domain optical coherence tomography.
In conclusion, a moderate positive correlation was found between the elevation of AST/ALT and the amount of intraretinal fluid. Elevated liver enzymes may provide a biomarker indicating a greater risk for retinal complications such as intraretinal fluid and may indicate a need for retinal examination in patients with pre-eclampsia.
Footnotes and Disclosure
The authors have no proprietary or commercial interest in any materials discussed in this article.
References
- Preeclampsia and long-term risk of maternal retinal disorders.Obstet Gynecol. 2017; 129: 42-49
- Retinopathy in preeclampsia: association with birth weight and uric acid level.Retina. 2008; 28: 1104-1110
- The prevalence of retinal and optical coherence tomography findings in preeclamptic women.Retina. 2014; 34: 1376-1383
- Macular thickness measured by optical coherence tomography correlates with proteinuria in pre-eclampsia.Pregnancy Hypertens. 2012; 2: 387-392
- Choroidal and retinal thickening in severe preeclampsia.Invest Ophthalmol Vis Sci. 2014; 55: 5723-5729
- Characteristic SD-OCT findings in preeclampsia.Ophthalmic Surg Lasers Imaging. 2012; 43: S139-S141
Article Info
Publication History
Published online: August 26, 2020
Accepted:
June 9,
2020
Received in revised form:
May 15,
2020
Received:
March 15,
2020
Identification
Copyright
© 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
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