Bilateral serous retinal detachment: an unusual complication of HELLP syndrome

Abstract

A 23-year-old primigravida presented to the emergency department with reports of headache. On examination, her blood pressure was found to be 190/140 mm Hg. Her laboratory results were notable for proteinuria, deranged liver function and low platelets. She was diagnosed with HELLP syndrome and was delivered via caesarean section. She noticed diminution of vision 2 days after delivery. Fundus examination revealed bilateral serous retinal detachment involving the maculae. She was managed conservatively and had complete recovery of her vision by 3 weeks postpartum.

Clinical Course of OCTA en face Imaging Findings in a Patient with HELLP Syndrome

“…Furthermore, the study also revealed that outcomes for visual acuity were more favorable for patients with preeclampsia than for patients with malignant hypertension, with exacerbating factors including the presence of hypertensive retinopathy and macula location of the SRD [14]. Our patient needed more time to achieve improvement in visual function compared with previous cases [5,6,13].…”

“…The pathomechanism is proposed to involve generalized endothelial dysfunction and vasospasm in the maternal circulation, resulting in ischemia in retinal pigment epithelium (RPE) and choroid and secondary impairments to the retina [ 10 , 11 , 12 ]. As for visual prognosis, previous case reports have described resolution of SRD within a few weeks to months after treatment of the mother (e.g., emergency cesarean section) [ 5 , 6 , 13 ]. Although few studies have reported factors contributing to the visual prognosis, Lee et al [ 14 ] reported features and factors for visual prognosis in patients with preeclampsia compared with those in patients with malignant hypertension.…”

“…Almost all previous cases showed recovery of visual function within a few weeks to months [ 5 , 6 , 13 ]. However, our patient did not show improvement in visual acuity within a few months after the onset despite the outer retinal layers appearing almost normal.…”

“…Clinical findings of ocular complications associated with preeclampsia or HELLP syndrome have been reported in the form of various funduscopic findings, including retinal hemorrhage, Elschnig spots, papilledema, and serous retinal detachment (SRD) [ 5 ]. Recent case reports have described the detailed clinical course in patients with bilateral SRD due to preeclampsia with HELLP syndrome [ 5 , 6 ]. However, few case reports have focused on correlations between visual prognosis and clinical findings.…”