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Bilateral serous retinal detachment complicating preeclampsia
G Model INJMS 158 No. of Pages 4
Indian Journal of Medical Specialities xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Indian Journal of Medical Specialities journal homepage: www.elsevier.com/locate/injms
Case report
Bilateral serous retinal detachment complicating preeclampsia Taoufik Abdellaoui* , Ghita Bouayad, Adil Elkhoyaali, Nisrine Laaribi, Yassine Mouzari, Fouad Elasri, Karim Reda, Abdelbarre Oubaaz Department of Ophthalmology, Military Teaching Hospital Med-V, University of Mohammed-V, Rabat, Morocco
A R T I C L E I N F O
Article history: Received 29 October 2017 Received in revised form 26 November 2017 Accepted 27 November 2017 Available online xxx Keywords: Preeclampsia Retinal detachment Choroidal ischemia Arteriolar vasospasm
A B S T R A C T
Preeclampsia is an obstetric complication that affects approximately 5% of pregnant women. The visual system may be affected with variable manifestations and variable intensity. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis may be related to the choroïdal ischemia secondary to arteriolar vasospasm. We report a case of 36-year-old woman who developed severe preeclampsia in her first pregnancy with blurred vision secondary to bilateral serous retinal detachment. © 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
1. Introduction Pregnancy is associated with many physiologic and pathologic changes. One of the most important pathologic changes is the preeclampsia/eclampsia syndrome, also known as “toxemia of pregnancy”. It is a multisystem disorder affecting many body systems and cause of maternal and fetal morbidity as well as mortality. Visual symptoms concern up to 25% of patients with severe preeclampsia, and various ocular manifestations have been described. Serous retinal detachment (SRD) is an unusual cause of visual loss in preeclampsia. A case of a patient who developed severe preeclampsia in association with bilateral SRD is presented. 2. Case report A 36-year-old primiparous woman presented to the emergency at 34 weeks of gestation with headache and generalized edema and blurred vision in both eyes. Past medical history was unremarkable. General examination found high blood pressure at 220/ 130 mmHg, heart rate at 95 beats per minute (bpm), and fetal heart rate was 130 bpm. Dipstick urinary proteinuria was detected (3+), 24-h urinary protein was 1.9 g/l, and liver enzyme level was elevated. The patient was hospitalized and a cesarean section was decided. By the first postpartum day, blood pressure returned to normal levels, and edema started regressing, but visual symptoms
* Corresponding author at: Foyer des médecins internes, Hôpital Avicenne, Rabat, Postal code: 10045, Morocco. E-mail address: [email protected] (T. Abdellaoui).
persisted. It was prescribed furosemide 40 mg/day, and she was kept at bed rest. Ophthalmologic examination found a visual acuity (VA) at 6/9 on the right eye and 6/30 on the left one. Anterior segment was normal. Fundus examination revealed bullous serous retinal detachment in both eyes (Fig. 1). Optical coherence tomography (OCT), an examination that shows images like almost histologic section of retina, confirmed retinal serous detachment with foveal uprising in the left eye (Fig. 2). Acetazolamide per os was then started at 250 mg 3 times a day. Two weeks later, her VA had improved to 6/6 in both eyes. Fundus examination (Fig. 3) and macular OCT (Fig. 4) showed complete resorption of the retinal serous detachment. Fluorescein angiography performed, one month postpartum, to look for choroidal sequelae such as choroidal ischemia that would be manifested by a delay and an irregular filling of choroidal vessels with fluorescein, and fluorescein diffusion through the vascular wall which reflects their hyper permeability; in our case, fluorescein angiography was normal, indicating complete recovery of choroidal blood flow. No ocular complications were found during six months follow-up. 3. Discussion Preeclampsia is a hypertensive disease of pregnancy due to abnormal utero-placental circulation. Hypoperfusion of the placenta and hypoxia of the intervillous space are responsible for placental dysfunction. Trophoblastic factors are released in the maternal circulation and are responsible for general maternal endothelial dysfunction that characterize preeclampsia [1,2]. Clinically, preeclampsia is defined as the new onset of hypertension with blood pressure 140/90 mmHg, and proteinuria 300
https://doi.org/10.1016/j.injms.2017.11.004 0976-2884/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
2
T. Abdellaoui et al. / Indian Journal of Medical Specialities xxx (2017) xxx–xxx
Fig. 1. Color fundus photographs (R: Right eye, L: Left eye): multiple serous peripapillary retinal detachment extending to the macula (arrows).
Fig. 2. Macular OCT: Serous retinal detachment in both eyes with separation of the neurosensory retina (black arrow), and pigmented epithelium (with arrow) by subretinal fluid (asterisk).
Fig. 3. Color fundus photographs 2 weeks later (R: Right eye, L: Left eye): complete resorption of SRD in both eyes.
mg/day during the second half of pregnancy [2]. Eclampsia is characterized by the appearance of tonic-clonic seizures in a patient who had developed preeclampsia. It’s a multisystem disorder that can include various body systems and organs: cardiovascular, hematologic, hepatic, renal and neurologic abnormalities. Visual system can also be affected. Ophthalmological disorders are mainly due to arteriolar spasm and its consequences in retinal and choroïdal vascular networks [3]. During pregnancy, some preexisting ocular diseases may be exacerbated such as diabetic retinopathy and uveitis. Other
pregnancy-specific eye diseases (Table 1) may appear as complications of preeclampsia/eclampsia [4]. Visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia, visual field defects, may be attributed to posterior cerebral artery vasospasm with ischemia, or to cerebral edema in the occipital area. Although abnormalities of the conjunctiva, retina and retinal vasculature, choroid, optic nerve, and visual cortex have been reported, the most common ocular finding is constriction of retinal arterioles found in 60–70% of cases [4,5].
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
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3
Fig. 4. Macular OCT 2 weeks later: complete resorption of SRD.
Table 1 Ocular complications of Eclampsia/Preeclampsia. Frequency reported in the literature Arteriolar spasm at funduscopy and angiography (vasculature of the retina, choroid and optic nerve head) with or without 60–70% [4,5] visual clinical symptoms 25% of preeclamptic, 19% to 45% of eclamptic Visual symptoms (blurry vision, diplopia, amaurosis fugax, photopsia, visual field defects) women [4,5,6,7] Serous retinal detachment 1% for severe preeclampsia, 10% for eclamptic patients [3,8] Cortical blindness 1–15% of patients with severe preeclampsia and eclampsia [9] Other complications: retinal artery occlusion, retinal vein occlusion, vitreous hemorrhage, optic ischemic neuropathy, Very rare optic atrophy, optic neuritis, Purtscher-like retinopathy
Serous retinal detachment is an unusual cause of visual loss in (pre)eclampsia, its incidence is approximately 1% for severe preeclampsia and 10% for eclamptic patients. It results from a localized serous detachment of the neurosensory retina from retinal pigmented epithelium (RPE). The role of retinal pigmented epithelium is facilitates the exchange of water, salts, nutrients, and metabolites between the retina and the choroid, and prevents the accumulation of fluid in the subretinal space. Tight junctions between the RPE cells form the blood-retinal barrier, which can be disturbed by many conditions such as severe acute hypertension. In preeclampsia/eclampsia, the choroidal ischemia, secondary to intensive arteriolar vasospasm can result in lesions in retinal pigment epithelium, fluid transudation through choroidal vessels to subretinal space, leading to focal retinal detachment [10,11]. When this transudation is massive, it may induce total retinal detachment. SRD typically resolves by 1 or 2 months after delivery [12]. The majority of patients who manifest serous detachment during pregnancy have, with clinical management, complete recovery within weeks after delivery. Some macular sequelae may persist, specially in the pigment epithelium. Acute cortical blindness is one of the most dramatic presentations of (pre)eclampsia. It is defined as blindness occurring in association with normal fundoscopy and pupillary function. Cortical blindness occurs, in most cases, several hours before or after eclamptic seizures and rarely, for several days postpartum. The bilateral vision loss often begins with blurry vision and progresses within a couple of hours. It’s an anxiety-provoking condition that fortunately resolves completely in most cases within few days. Its exact mechanism is unclear, it has been postulated that cortical blindness may appear as a consequence of generalized cerebrovascular vasospasm and ischemic injury or from vasogenic edema due to increased capillary permeability. In
this case, clinical manifestations would result from increased susceptibility of occipital lobes to cerebral blood supply reductions. This increased susceptibility may be explained by the fact that occipital lobes are located in a cerebral blood supply borderzone or by selective vasospasm of the posterior cerebral artery, producing a dramatic reduction of blood to occipital areas [13]. Other very rare ocular complications, whose pathophysiology in (pre)eclampsia is not fully understood, have been described, including retinal artery and vein occlusion, vitreous hemorrhage, ischemic optic neuropathy, optic atrophy, optic neuritis, and Purtscher-like retinopathy [3]. Purtscher’s retinopathy, is a specific appearance of the fundus characterized by multiple areas of retinal whitening and intraretinal hemorrhages, usually caused by trauma. Some (pre)eclampsia cases have been associated with the same specific appearance of the fundus, and which was therefore named Purtscher-like retinopathy [8]. After preeclampsia, long term follow-up is recommended; preeclampsia is a significant risk factor for long-term ophthalmic complications. Specifically, diabetic retinopathy, proliferative retinopathy as a consequence of ischemia following microthrombus formation in the periphery of the retinal microcirculation, and retinal detachment were found to be significantly associated with a history of preeclampsia [3,14]. In conclusion, preeclampsia can affect the eye in a variable severity. Serous retinal detachment is a rare complication resulting from choroidal arteriolar vasospasm. After delivery, this complication resolves spontaneously in the majority of cases, but a longterm follow up is necessary. Conflicts of interest Authors have no conflict of interest.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
4
T. Abdellaoui et al. / Indian Journal of Medical Specialities xxx (2017) xxx–xxx
References [1] Lecarpentier E, Fournier T, Guibourdenche J. Physiopathologie de la prééclampsie. La Presse Médicale 2016;45(7, Part 1):631–7. [2] Noris M, Perico N, Remuzzi G. Mechanisms of disease: pre-eclampsia. Nat Clin Pract Nephrol 2005;1(2)98–114 quiz 120. [3] Abu Samra K. The eye and visual system in the preeclampsia/eclampsia syndrome: what to expect? Saudi J Ophthalmol 2013;27(1):51–3. [4] Schultz KL, Birnbaum AD, Goldstein DA. Ocular disease in pregnancy. Curr Opin Ophthalmol 2005;16(5):308–14. [5] Jaffe G, Schatz H. Ocular manifestations of preeclampsia. Am J Ophthalmol 1987;103(3 Pt 1):309–15. [6] Sunness JS. The pregnant woman's eye. Surv Ophthalmol 1988;32(4):219–38. [7] Cooray SD, Edmonds SM, Tong S, Samarasekera SP, Whitehead CL. Characterization of symptoms immediately preceding eclampsia. Obstet Gynecol 2011;118(5):995–9. [8] Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv 2012;67(4):242–50.
[9] Cunningham FG, Fernandez CO, Hernandez C. Blindness associated with preeclampsia and eclampsia. Am J Obstet Gynecol 1995;172(4 Pt 1):1291–8. [10] 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;22(3):520–4. [11] Bos AM, van Loon AJ, Ameln JG. Serous retinal detachment in preeclampsia. Nederlands tijdschrift voor geneeskunde 1999;143(48):2430–2. [12] Haimovici R, Koh S, Gagnon DR, Lehrfeld T, Wellik S. Risk factors for central serous chorioretinopathy: a case-control study. Ophthalmology 2004;111 (2):244–9. [13] Torres PJ, Antolin E, Gratacos E, Chamorro A, Cararach V. Cortical blindness in preeclampsia: diagnostic evaluation by transcranial Doppler and magnetic resonance imaging techniques. Acta obstetricia et gynecologica Scandinavica 1995;74(8):642–4. [14] Beharier O, Davidson E, Sergienko R, Szaingurten-Solodkin I, Kessous R, Charach R, Belfair NJ, Sheiner E. Preeclampsia and future risk for maternal ophthalmic complications. Am J Perinatol 2016;33(7):703–7.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
Indian Journal of Medical Specialities xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Indian Journal of Medical Specialities journal homepage: www.elsevier.com/locate/injms
Case report
Bilateral serous retinal detachment complicating preeclampsia Taoufik Abdellaoui* , Ghita Bouayad, Adil Elkhoyaali, Nisrine Laaribi, Yassine Mouzari, Fouad Elasri, Karim Reda, Abdelbarre Oubaaz Department of Ophthalmology, Military Teaching Hospital Med-V, University of Mohammed-V, Rabat, Morocco
A R T I C L E I N F O
Article history: Received 29 October 2017 Received in revised form 26 November 2017 Accepted 27 November 2017 Available online xxx Keywords: Preeclampsia Retinal detachment Choroidal ischemia Arteriolar vasospasm
A B S T R A C T
Preeclampsia is an obstetric complication that affects approximately 5% of pregnant women. The visual system may be affected with variable manifestations and variable intensity. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis may be related to the choroïdal ischemia secondary to arteriolar vasospasm. We report a case of 36-year-old woman who developed severe preeclampsia in her first pregnancy with blurred vision secondary to bilateral serous retinal detachment. © 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
1. Introduction Pregnancy is associated with many physiologic and pathologic changes. One of the most important pathologic changes is the preeclampsia/eclampsia syndrome, also known as “toxemia of pregnancy”. It is a multisystem disorder affecting many body systems and cause of maternal and fetal morbidity as well as mortality. Visual symptoms concern up to 25% of patients with severe preeclampsia, and various ocular manifestations have been described. Serous retinal detachment (SRD) is an unusual cause of visual loss in preeclampsia. A case of a patient who developed severe preeclampsia in association with bilateral SRD is presented. 2. Case report A 36-year-old primiparous woman presented to the emergency at 34 weeks of gestation with headache and generalized edema and blurred vision in both eyes. Past medical history was unremarkable. General examination found high blood pressure at 220/ 130 mmHg, heart rate at 95 beats per minute (bpm), and fetal heart rate was 130 bpm. Dipstick urinary proteinuria was detected (3+), 24-h urinary protein was 1.9 g/l, and liver enzyme level was elevated. The patient was hospitalized and a cesarean section was decided. By the first postpartum day, blood pressure returned to normal levels, and edema started regressing, but visual symptoms
* Corresponding author at: Foyer des médecins internes, Hôpital Avicenne, Rabat, Postal code: 10045, Morocco. E-mail address: [email protected] (T. Abdellaoui).
persisted. It was prescribed furosemide 40 mg/day, and she was kept at bed rest. Ophthalmologic examination found a visual acuity (VA) at 6/9 on the right eye and 6/30 on the left one. Anterior segment was normal. Fundus examination revealed bullous serous retinal detachment in both eyes (Fig. 1). Optical coherence tomography (OCT), an examination that shows images like almost histologic section of retina, confirmed retinal serous detachment with foveal uprising in the left eye (Fig. 2). Acetazolamide per os was then started at 250 mg 3 times a day. Two weeks later, her VA had improved to 6/6 in both eyes. Fundus examination (Fig. 3) and macular OCT (Fig. 4) showed complete resorption of the retinal serous detachment. Fluorescein angiography performed, one month postpartum, to look for choroidal sequelae such as choroidal ischemia that would be manifested by a delay and an irregular filling of choroidal vessels with fluorescein, and fluorescein diffusion through the vascular wall which reflects their hyper permeability; in our case, fluorescein angiography was normal, indicating complete recovery of choroidal blood flow. No ocular complications were found during six months follow-up. 3. Discussion Preeclampsia is a hypertensive disease of pregnancy due to abnormal utero-placental circulation. Hypoperfusion of the placenta and hypoxia of the intervillous space are responsible for placental dysfunction. Trophoblastic factors are released in the maternal circulation and are responsible for general maternal endothelial dysfunction that characterize preeclampsia [1,2]. Clinically, preeclampsia is defined as the new onset of hypertension with blood pressure 140/90 mmHg, and proteinuria 300
https://doi.org/10.1016/j.injms.2017.11.004 0976-2884/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
2
T. Abdellaoui et al. / Indian Journal of Medical Specialities xxx (2017) xxx–xxx
Fig. 1. Color fundus photographs (R: Right eye, L: Left eye): multiple serous peripapillary retinal detachment extending to the macula (arrows).
Fig. 2. Macular OCT: Serous retinal detachment in both eyes with separation of the neurosensory retina (black arrow), and pigmented epithelium (with arrow) by subretinal fluid (asterisk).
Fig. 3. Color fundus photographs 2 weeks later (R: Right eye, L: Left eye): complete resorption of SRD in both eyes.
mg/day during the second half of pregnancy [2]. Eclampsia is characterized by the appearance of tonic-clonic seizures in a patient who had developed preeclampsia. It’s a multisystem disorder that can include various body systems and organs: cardiovascular, hematologic, hepatic, renal and neurologic abnormalities. Visual system can also be affected. Ophthalmological disorders are mainly due to arteriolar spasm and its consequences in retinal and choroïdal vascular networks [3]. During pregnancy, some preexisting ocular diseases may be exacerbated such as diabetic retinopathy and uveitis. Other
pregnancy-specific eye diseases (Table 1) may appear as complications of preeclampsia/eclampsia [4]. Visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia, visual field defects, may be attributed to posterior cerebral artery vasospasm with ischemia, or to cerebral edema in the occipital area. Although abnormalities of the conjunctiva, retina and retinal vasculature, choroid, optic nerve, and visual cortex have been reported, the most common ocular finding is constriction of retinal arterioles found in 60–70% of cases [4,5].
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
T. Abdellaoui et al. / Indian Journal of Medical Specialities xxx (2017) xxx–xxx
3
Fig. 4. Macular OCT 2 weeks later: complete resorption of SRD.
Table 1 Ocular complications of Eclampsia/Preeclampsia. Frequency reported in the literature Arteriolar spasm at funduscopy and angiography (vasculature of the retina, choroid and optic nerve head) with or without 60–70% [4,5] visual clinical symptoms 25% of preeclamptic, 19% to 45% of eclamptic Visual symptoms (blurry vision, diplopia, amaurosis fugax, photopsia, visual field defects) women [4,5,6,7] Serous retinal detachment 1% for severe preeclampsia, 10% for eclamptic patients [3,8] Cortical blindness 1–15% of patients with severe preeclampsia and eclampsia [9] Other complications: retinal artery occlusion, retinal vein occlusion, vitreous hemorrhage, optic ischemic neuropathy, Very rare optic atrophy, optic neuritis, Purtscher-like retinopathy
Serous retinal detachment is an unusual cause of visual loss in (pre)eclampsia, its incidence is approximately 1% for severe preeclampsia and 10% for eclamptic patients. It results from a localized serous detachment of the neurosensory retina from retinal pigmented epithelium (RPE). The role of retinal pigmented epithelium is facilitates the exchange of water, salts, nutrients, and metabolites between the retina and the choroid, and prevents the accumulation of fluid in the subretinal space. Tight junctions between the RPE cells form the blood-retinal barrier, which can be disturbed by many conditions such as severe acute hypertension. In preeclampsia/eclampsia, the choroidal ischemia, secondary to intensive arteriolar vasospasm can result in lesions in retinal pigment epithelium, fluid transudation through choroidal vessels to subretinal space, leading to focal retinal detachment [10,11]. When this transudation is massive, it may induce total retinal detachment. SRD typically resolves by 1 or 2 months after delivery [12]. The majority of patients who manifest serous detachment during pregnancy have, with clinical management, complete recovery within weeks after delivery. Some macular sequelae may persist, specially in the pigment epithelium. Acute cortical blindness is one of the most dramatic presentations of (pre)eclampsia. It is defined as blindness occurring in association with normal fundoscopy and pupillary function. Cortical blindness occurs, in most cases, several hours before or after eclamptic seizures and rarely, for several days postpartum. The bilateral vision loss often begins with blurry vision and progresses within a couple of hours. It’s an anxiety-provoking condition that fortunately resolves completely in most cases within few days. Its exact mechanism is unclear, it has been postulated that cortical blindness may appear as a consequence of generalized cerebrovascular vasospasm and ischemic injury or from vasogenic edema due to increased capillary permeability. In
this case, clinical manifestations would result from increased susceptibility of occipital lobes to cerebral blood supply reductions. This increased susceptibility may be explained by the fact that occipital lobes are located in a cerebral blood supply borderzone or by selective vasospasm of the posterior cerebral artery, producing a dramatic reduction of blood to occipital areas [13]. Other very rare ocular complications, whose pathophysiology in (pre)eclampsia is not fully understood, have been described, including retinal artery and vein occlusion, vitreous hemorrhage, ischemic optic neuropathy, optic atrophy, optic neuritis, and Purtscher-like retinopathy [3]. Purtscher’s retinopathy, is a specific appearance of the fundus characterized by multiple areas of retinal whitening and intraretinal hemorrhages, usually caused by trauma. Some (pre)eclampsia cases have been associated with the same specific appearance of the fundus, and which was therefore named Purtscher-like retinopathy [8]. After preeclampsia, long term follow-up is recommended; preeclampsia is a significant risk factor for long-term ophthalmic complications. Specifically, diabetic retinopathy, proliferative retinopathy as a consequence of ischemia following microthrombus formation in the periphery of the retinal microcirculation, and retinal detachment were found to be significantly associated with a history of preeclampsia [3,14]. In conclusion, preeclampsia can affect the eye in a variable severity. Serous retinal detachment is a rare complication resulting from choroidal arteriolar vasospasm. After delivery, this complication resolves spontaneously in the majority of cases, but a longterm follow up is necessary. Conflicts of interest Authors have no conflict of interest.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004
G Model INJMS 158 No. of Pages 4
4
T. Abdellaoui et al. / Indian Journal of Medical Specialities xxx (2017) xxx–xxx
References [1] Lecarpentier E, Fournier T, Guibourdenche J. Physiopathologie de la prééclampsie. La Presse Médicale 2016;45(7, Part 1):631–7. [2] Noris M, Perico N, Remuzzi G. Mechanisms of disease: pre-eclampsia. Nat Clin Pract Nephrol 2005;1(2)98–114 quiz 120. [3] Abu Samra K. The eye and visual system in the preeclampsia/eclampsia syndrome: what to expect? Saudi J Ophthalmol 2013;27(1):51–3. [4] Schultz KL, Birnbaum AD, Goldstein DA. Ocular disease in pregnancy. Curr Opin Ophthalmol 2005;16(5):308–14. [5] Jaffe G, Schatz H. Ocular manifestations of preeclampsia. Am J Ophthalmol 1987;103(3 Pt 1):309–15. [6] Sunness JS. The pregnant woman's eye. Surv Ophthalmol 1988;32(4):219–38. [7] Cooray SD, Edmonds SM, Tong S, Samarasekera SP, Whitehead CL. Characterization of symptoms immediately preceding eclampsia. Obstet Gynecol 2011;118(5):995–9. [8] Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv 2012;67(4):242–50.
[9] Cunningham FG, Fernandez CO, Hernandez C. Blindness associated with preeclampsia and eclampsia. Am J Obstet Gynecol 1995;172(4 Pt 1):1291–8. [10] 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;22(3):520–4. [11] Bos AM, van Loon AJ, Ameln JG. Serous retinal detachment in preeclampsia. Nederlands tijdschrift voor geneeskunde 1999;143(48):2430–2. [12] Haimovici R, Koh S, Gagnon DR, Lehrfeld T, Wellik S. Risk factors for central serous chorioretinopathy: a case-control study. Ophthalmology 2004;111 (2):244–9. [13] Torres PJ, Antolin E, Gratacos E, Chamorro A, Cararach V. Cortical blindness in preeclampsia: diagnostic evaluation by transcranial Doppler and magnetic resonance imaging techniques. Acta obstetricia et gynecologica Scandinavica 1995;74(8):642–4. [14] Beharier O, Davidson E, Sergienko R, Szaingurten-Solodkin I, Kessous R, Charach R, Belfair NJ, Sheiner E. Preeclampsia and future risk for maternal ophthalmic complications. Am J Perinatol 2016;33(7):703–7.
Please cite this article in press as: T. Abdellaoui, et al., Bilateral serous retinal detachment complicating preeclampsia, Indian J Med Spec. (2017), https://doi.org/10.1016/j.injms.2017.11.004