Lee C, Hsu T Y, Ou C Y, Chang S Y, Soong Y K
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taipei, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi. 1999 Sep;22(3):520-4.
Retinal detachment is an unusual complication of hypertensive disorder in pregnancy. It has been reported in 1% to 2% of patients with severe preeclampsia and in 10% of patients with eclampsia. Choroidal ischemia may be the cause of retinal detachment. We know that mild arteriolar spasm involving the bulbar conjunctival vessels has been observed in the normal pregnancy, but in pregnancy-induced hypertension the vasospasm may be severe and result in choroidal ischemia. Most patients with retinal detachment in pregnancy-induced hypertension have had full spontaneous resolution within a few weeks, and they did not have any sequelae. Medical treatment with antihypertensive drugs and steroids may be helpful. We report two rare cases of retinal detachment and persistent hypertension in association with postpartum eclampsia and post-cesarean section preeclampsia. These patients had normotension throughout pregnancy. Preeclampsia or eclampsia developed after delivery, and blurred vision, headache, and reduced vision accompanied serous retinal detachment. The serous retinal detachment disappeared within 3 weeks. Good outcomes were found in the follow-up examinations in both of these cases. For women who had been normotensive at the time of delivery and then complained in the postpartum period of blurred vision, headaches, nausea and vomiting, we should consider the possibility of retinal detachment and perform fundoscopy.
视网膜脱离是妊娠期高血压疾病的一种罕见并发症。据报道,重度子痫前期患者中1%至2%会出现视网膜脱离,子痫患者中则有10%会出现。脉络膜缺血可能是视网膜脱离的原因。我们知道,在正常妊娠中可观察到累及球结膜血管的轻度小动脉痉挛,但在妊娠高血压综合征中,血管痉挛可能很严重并导致脉络膜缺血。大多数妊娠期高血压视网膜脱离患者在几周内可完全自发缓解,且无任何后遗症。使用降压药和类固醇进行药物治疗可能会有帮助。我们报告了两例罕见的视网膜脱离合并持续性高血压的病例,分别与产后子痫和剖宫产术后子痫前期相关。这些患者在整个孕期血压正常。分娩后出现子痫前期或子痫,同时浆液性视网膜脱离伴有视力模糊、头痛和视力下降。浆液性视网膜脱离在3周内消失。这两例患者的随访检查结果均良好。对于分娩时血压正常但产后出现视力模糊、头痛、恶心和呕吐的女性,我们应考虑视网膜脱离的可能性并进行眼底镜检查。