Case Report: Optical Coherence Tomography Can Find Typical Features in Pregnancy-induced Hypertension with Retinopathy

Abstract

SIGNIFICANCE Pregnancy-induced hypertension is a unique yet common complication in pregnant women and may cause retinopathy. Optical coherence tomography (OCT) may help find the features of retinopathy that are difficult to observe through fundus examination. Not all patients can fully recover from retinopathy. PURPOSE This report describes a case of pregnancy-induced hypertension with retinopathy and represents the features of retinopathy in OCT and fundus fluorescein angiography. CASE REPORT A 29-year-old pregnant woman presented with bilateral blurred vision and xanthopsia 2 days before her induced labor; she was also diagnosed as pre-eclamptic in the obstetrics department. The vision in her right eye was 20/33, and that in her left eye was 20/20. Fundus fluorescein angiography showed scattered-dot hypofluorescence around the disc at an early stage, and needle-like hyperfluorescence gradually appeared near the disc with late-stage fluorescein leakage in both eyes. Optical coherence tomography revealed multiple shallow retinal detachments with hyperreflective bright spots in the outer retina and clumped hyperreflective materials on the retinal pigment epithelium (RPE). CONCLUSIONS Typical findings and some tiny changes in the outer retina and RPE can be observed through spectral-domain OCT. The clumped hyperreflective deposits in the outer retina may be by-products of RPE swelling and necrosis that lead to barrier dysfunctions and fluid leakage. These described features may help diagnose retinopathy from pregnancy-induced hypertension. Although it is a self-limited disease, the disruptions in the ellipsoid and interdigitation zones may not fully recover and result in reduced visual dysfunction. Therefore, control of hypertension is indicated.

Hypertensive Retinopathy in Guinean Hypertensive Women: Epidemiological, Clinical and Therapeutic Aspects

“…The hypertensive retinopathy was frequent at 61.75%, our result is higher than that of Zhenzhen et al [11] which had found 32.5% of patients with hypertensive retinopathy then this difference would explain the occurrence of complications of hypertension, which are more present in women after 60 years old.…”

Vision loss in a pregnant woman with nephrotic syndrome

“…12 On the other hand, a diversity of retinal abnormalities has been reported during complicated pregnancy, including subretinal fluid (SRF), subretinal fibrin-like material (SRFM), retinal detachement (RD) with punctate Elschnig's spots, PEDs, clumped hyperreflective materials on the RPE, hypertensive retinopathy and choroidopathy, retinal hemorrhage, bilateral macular hemorrhage and a thickened choroid at the macula combined with pregnancy-induced hypertension (PIH) or HELLP syndrome. [13][14][15][16][17][18][19] Ocular abnormalities, especially PED and cystoid macular edema have been interrelated with both pregnancy and NS, as a corollary of secondary disorders. Additionally, the prevalence of PED and CME associated with NS is unknown.…”

“…On the other hand, a diversity of retinal abnormalities has been reported during complicated pregnancy, including subretinal fluid (SRF), subretinal fibrin-like material (SRFM), retinal detachement (RD) with punctate Elschnig's spots, PEDs, clumped hyperreflective materials on the RPE, hypertensive retinopathy and choroidopathy, retinal hemorrhage, bilateral macular hemorrhage and a thickened choroid at the macula combined with pregnancy-induced hypertension (PIH) or HELLP syndrome. 13–19…”

A algorithm for prediction of exudative retinal detachment risk of patients with pregnancy-induced hypertension

“…The happening of the ERD could mean a higher risk of core outcomes: stillbirth, small gestational age at delivery, lower birthweight, cardiovascular disease, neonatal mortality, seizures, admission to neonatal unit required and respiratory support [14][15] . Although most patients with ERD have good visual prognosis, but some patients have sustained damage in RPE layer and ellipsoid zone, which can lead to permanent loss of visual function in severe cases [16] . Therefore, identifying and intervening the risk factors related to ERD in pregnancy with hypertension can effectively reduce the abnormal pregnancy rate.…”