Ocular Manifestations: Are They Significant in Hypertensive Disorders of Pregnancy?

Abstract

Background Hypertensive disorders of pregnancy lead to pathological changes in various organ systems of mother and fetus which contributes to maternal and fetal morbidity and mortality. It is a multisystem disorder which can involve end organs like kidneys, liver, eyes, hemopoietic system and placenta. Retinal involvement, though quite common, is rarely investigated. It is a unique site where the blood vessels can be directly observed. Observing retinal vasculature may provide clue to status of similar vessels in other parts of body including placental circulation. Methods Hospital-based descriptive study which included 150 patients diagnosed as preeclampsia/eclampsia, who were admitted in the intensive care unit. Written consent was obtained from study subjects. Data were collected by history taking and examination of the subjects using pre-structured questionnaire. Ocular examination was carried out by ophthalmologist, which included anterior segment examination, visual acuity and dilated fundus examination. Multiple qualitative and quantitative parameters were studied. Data were analyzed by SPSS 14.0 software. Results Ocular symptoms were seen in 22% of severe preeclampsia and in 100% of eclampsia patients. Blurred vision was the most common ocular complaint. Fundus changes were seen in 48.7% total study subjects. Arteriolar narrowing was the most common finding on fundus examination. Systolic blood pressure and serum creatinine were found predictive of changes in fundus (p = .000). Incidence of fetal growth restriction was found to be significantly associated with fundus involvement (p value .000). Conclusion Ophthalmic examination including fundus examination should be a routine in the investigational armamentarium of hypertensive disorders of pregnancy.

Manifestasi Okular pada Preeklampsia

“…4 Penglihatan kabur (blurred vision) merupakan gejala okular preeklampsia yang paling sering dilaporkan. [5][6][7] Beberapa penelitian melaporkan gejala okular preeklampsia dalam jumlah yang tidak dapat diabaikan, yaitu 22%-45%. [5][6][7] Gejala okular umumnya segera mengalami resolusi spontan setelah terapi preeklampsia yang adekuat.…”

“…[5][6][7] Beberapa penelitian melaporkan gejala okular preeklampsia dalam jumlah yang tidak dapat diabaikan, yaitu 22%-45%. [5][6][7] Gejala okular umumnya segera mengalami resolusi spontan setelah terapi preeklampsia yang adekuat. 4 Secara anatomis, preeklampsia-eklampsia dapat menyebabkan gangguan segmen anterior, segmen posterior, bahkan hingga korteks visual.…”

“…(2021) di India menunjukkan bahwa gejala okular dilaporkan pada 22% pasien preeklampsia dan 100% pasien eklampsia. 6 Pola serupa juga ditemukan oleh Mushumbusi, dkk. (2016), yaitu gejala okular lebih banyak dilaporkan oleh pasien eklampsia (74%) dibanding pasien preeklampsia (51%).…”

“…7 Penglihatan kabur (blurred vision) merupakan gejala okular preeklampsia yang paling sering dilaporkan. [5][6][7] Gejala okular lain berupa penglihatan kabur, penglihatan ganda, kehilangan penglihatan yang bersifat sementara, defek lapang pandang, kilatan cahaya (photopsia), fotopobia, hingga nyeri pada mata. 4,7 Seorang pasien dapat mengalami lebih dari satu gejala.…”

“…(2021) di India menunjukkan penurunan visus antara 6/12 hingga 6/60. 6 Penelitian Mushumbusi, dkk. (2016) di Tanzania menyatakan penurunan visus <6/18 lebih sering terjadi pada pasien eklampsia (87%) dibanding pasien preeklampsia (13%).…”