Atlas of Ophthalmology

Bilateral Acute Serous Retinal Detachment and Macular Pigmentepithel Proliferation in Repeated Preeclampsia/ HELLP-Syndrome (Colour Photography Posterior Segment, SD-OCT)

Retina -> Aquired Macular Diseases
Patient: 29 years of age, female, BCVA 0.9 at OD, O.7 at OS. General Medical History: in 2005 severe preeclampsia with prompt cesarean delivery. In 01/2015 second severe preeclampsia and a prompt cesarean delivery at 32 weeks of gestation with history of headache, light flashes, blood pressure of 220/140 mm Hg and pedal edema. Ocular Medical History: in 01/2015 bilateral blurred vision and metamorphopsia accompanied by a decrease of visual acuity, on 04/2015 improvement of visual acuity . Purpose: to present presence of acute and old retinal alterations in repeated preeclampsia/ HELLP-Syndrome. Methods: Colour Photography Posterior Segment, Spectral Domain Optical Coherence Tomography (SD-OCT, Heidelberg Engineering, Heidelberg) Findings: SD-OCT: in 01/2015 acute serous retinal detachment in OD and OS. SD-OCT: in 04/2015 in OS macular pigmentepithel proliferation, no serous retinal detachment in OD and OS. The initial finding with serous retinal detachment has spontaneously resolved. Colour Photography Posterior Segment: in 04/2015 resting bilateral pigment epithel proliferation in macular region, no visible hemorrhages, cotton-wool spots. The initial finding with serous retinal detachment has spontaneously resolved. Discussion: Preeclampsia is one of the leading causes of perinatal and maternal mortality and morbidity across the world. This condition complicates approximately 3% to 7% of pregnancies, and the severe form affects 0.6% to 1.2% of pregnancies. Preeclampsia can cause grade 4 hypertensive retinopathy with hemorrhages, cotton-wool spots, hard exudates in the macular region, and swelling of the optic disks. The severe preeclampsia variant, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), occurs in approximately 20-25% of women with severe preeclampsia . It is named not only for the liver involvement but also for the disorder of the coagulation system which develops. Approximately 20% of women with HELLP syndrome develop disseminated intravascular coagulation, which carries a poor prognosis for both mother and fetus. Conditions other than preeclampsia can cause serous retinal detachments and choroidal thickening. Central serous retinopathy is hypothesized to be due to an overactivation of mineralocorticoid receptor pathway in the choroidal vasculature. Literature: (1) Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv. 2012 Apr;67(4):242-50. (2) Garg A, Wapner RJ, Ananth CV, Dale E, Tsang SH, Lee W, Allikmets R, Bearelly S. Choroidal and retinal thickening in severe preeclampsia. Invest Ophthalmol Vis Sci. 2014 Jul 29;55(9):5723-9.

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