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CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 62-64

A rare case of bilateral total retinal detachment in pre-eclampsic primigravida patient


1 Department of Ophthalmology, Calcutta National Medical College, Kolkata, West Bengal, India
2 Department of Ophthalmology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Chandana Chakraborti
A/1/1, Pearl Apartment, 50B, Kailash Bose Street, Kolkata - 700 006, West Bengal
India
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DOI: 10.4103/1858-540X.198542

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  Abstract 

Serous retinal detachment (RD) is a rare complication of pre-eclampsia in pregnancy. We report a case of a 23-year-old primigravida with pre-eclampsia in her third trimester of pregnancy developing bilateral RD at term. After delivery, there was spontaneous resolution of the serous RD. Her best-corrected visual acuity was 6/6 in the right eye and 6/9 in the left eye on 1-year follow-up. Management of pre-eclampsia-induced serous RD is conservative, and the prognosis is good.

Keywords: Eye in malignant hypertention, serous detachment, ocular changes in pre-eclamsia


How to cite this article:
Chakraborti C, Barua N, Malsawmtluanga M. A rare case of bilateral total retinal detachment in pre-eclampsic primigravida patient. Sudanese J Ophthalmol 2016;8:62-4

How to cite this URL:
Chakraborti C, Barua N, Malsawmtluanga M. A rare case of bilateral total retinal detachment in pre-eclampsic primigravida patient. Sudanese J Ophthalmol [serial online] 2016 [cited 2021 Jun 19];8:62-4. Available from: https://www.sjopthal.net/text.asp?2016/8/2/62/198542


  Introduction Top


Pre-eclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems, often the kidney. Ocular complications may occur in 30%-100% of pre-eclamptic patients. [1] Rarely, serous retinal detachment (RD) can occur as a complication due to the involvement of choroidal vascularization. The prognosis is usually good with conservative management. [2] We report this case of a pre-eclampsia-induced bilateral serous RD who recovered spontaneously with medical management.


  Case Report Top


A 23-year-old primigravida was admitted at term pregnancy with blood pressure of 190/10 mmHg and proteinuria 3+. She had irregular antenatal checkups elsewhere. Her pregnancy was uneventful until 7 days prior to admission when there was swelling of feet and dimness of vision in both eyes (BEs). She had intermittent high blood pressure records. She was immediately taken for cesarean section, which was uneventful. On the postoperative day 2, the patient was examined at bedside. Her visual acuity was perception of light positive with accurate projection of rays. Relative afferent pupillary reflex was present in the left eye (LE), with rest of the anterior segment being normal. Fundoscopy examination revealed bilateral serous bullous RD [Figure 1]. The patient was treated with antihypertensives and oral corticosteroids at a dose of 30 mg/day, tapered in 2 weeks.
Figure 1: Both eyes' total bullous serous retinal detachment

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On follow-up examination after 1 week, her best-corrected visual acuity (BCVA) was hand movement in the right eye (RE) and counting finger close to the face in the LE. Dilated fundus examination showed Bilateral bullous RD obscuring even the visualization of the disc [Figure 2]. Ultrasonography B-scan showed high-reflective membrane-like structure suggestive of RD with significant shift in location noted with change of position [Figure 3]. Two weeks postpartum, her BCVA improved to 6/18 in the RE and counting finger at 4 meter in the LE. Optical coherence tomography (OCT) demonstrated subretinal fluid more in the RE [Figure 4]. At 6 months, BCVA improved to 6/6 in the RE and 6/9 in the LE. OCT of the RE showed complete resolution of fluids, but the LE still showed multifocal residual retinal pigment epithelium (RPE) detachment [Figure 5]. On 1-year follow-up, BCVA was 6/6 with normal OCT findings in BEs.
Figure 2: Both eyes' bullous retinal detachment, only superior retina attached

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Figure 3: High-reflective membrane-like structure suggestive of retinal detachment. Significant shift in location noted with change of position

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Figure 4: Optical coherence tomography performed 2 weeks after delivery, demonstrated subretinal fluid, more expressed in the right eye

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Figure 5: Optical coherence tomography performed 6 months after delivery, demonstrated normal optical coherence tomography in the right eye but multiple pigment epithelial detachments in the left eye

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  Discussion Top


The incidence of pre-eclampsia is approximately 5%, and it is more common in primigravidas, in younger and older women, and in those patients with maternal systemic diseases. The onset of this disorder is usually at the third trimester of pregnancy. The most common ocular finding is focal retinal arteriolar narrowing, which may also diffuse. [1],[3]

Serous exudative RDs may occur in severe pre-eclamptic or eclamptic patients. It has been reported in 1%-2% of the patients with severe pre-eclampsia and in 10% of the patients with eclampsia. [4] They tend to be bilateral, bullous, and with pre-eclampsia retinopathy changes such as retinal hemorrhages, edema, and cotton-wool spots. Areas of nonperfusion or arterial or venous occlusive disease may also develop. [5]

The underlying mechanism is thought to be related to vasospasm leading to choroidal ischemia causing compromised fluid transport by the RPE, accumulation of subretinal fluid, and consequent serous neurosensory detachment. [6]

Most patients with serous detachment during pregnancy have, with conservative management, complete recovery within weeks after delivery, not requiring any surgical intervention. Some macular sequelae may persist, especially in the pigment epithelium. [7]

In our case, although the recovery was faster in the RE, in the LE, pigment epithelial detachment took almost 1 year to recover.


  Conclusion Top


Pre-eclampsia may cause bilateral serous RD which has a good prognosis if the causative factor is managed immediately. It may cause permanent blindness if it is not detected and treated on time. Therefore, a good coordination must be present between an obstetrician and an ophthalmologist to diagnose and manage these kinds of cases and help prevent blindness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ober RR. Pregnancy-induced hypertension (preeclampsia-eclampsia). In: Ryan SJ, editor. Retina. 2 nd ed., Vol. 2. St. Louis: Mosby; 1994. p. 1405-11.  Back to cited text no. 1
    
2.
Mihu D, Mihu CM, Talu S, Costin N, Ciuchina S, Malutan A. Ocular changes in preeclampsia. Oftalmologia 2008;52:16-22.  Back to cited text no. 2
    
3.
Wagner HP. Arterioles of the retina in toxaemia of pregnancy. JAMA 1933;101:1380-4.  Back to cited text no. 3
    
4.
Lee C, Hsu TY, Ou CY, Chang SY, Soong YK. Retinal detachment in postpartum preeclampsia and eclampsia: Report of two cases. Changgeng Yi Xue Za Zhi 1999;3:520-4.  Back to cited text no. 4
    
5.
Dinn RB, Harris A, Marcus PS. Ocular changes in pregnancy. Obstet Gynecol Surv 2003;58:137-44.  Back to cited text no. 5
    
6.
Saito Y, Tano Y. Retinal pigment epithelial lesions associated with choroidal ischemia in preeclampsia. Retina 1998;18:103-8.  Back to cited text no. 6
    
7.
Bos AM, van Loon AJ, Ameln JG. Serous retinal detachment in preeclampsia. Ned Tijdschr Geneeskd 1999;143:2430-2.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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