Zhang Zhenzhen, Lu Jianmin, Qin Xiuhong
Department of Ophthalmology, the Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China *
Optom Vis Sci. 2019 May;96(5):372-375. doi: 10.1097/OPX.0000000000001369.
Pregnancy-induced hypertension is a unique yet common complication in pregnant women and may cause retinopathy. Optical coherence tomography (OCT) may help find the features of retinopathy that are difficult to observe through fundus examination. Not all patients can fully recover from retinopathy.
This report describes a case of pregnancy-induced hypertension with retinopathy and represents the features of retinopathy in OCT and fundus fluorescein angiography.
A 29-year-old pregnant woman presented with bilateral blurred vision and xanthopsia 2 days before her induced labor; she was also diagnosed as pre-eclamptic in the obstetrics department. The vision in her right eye was 20/33, and that in her left eye was 20/20. Fundus fluorescein angiography showed scattered-dot hypofluorescence around the disc at an early stage, and needle-like hyperfluorescence gradually appeared near the disc with late-stage fluorescein leakage in both eyes. Optical coherence tomography revealed multiple shallow retinal detachments with hyperreflective bright spots in the outer retina and clumped hyperreflective materials on the retinal pigment epithelium (RPE).
Typical findings and some tiny changes in the outer retina and RPE can be observed through spectral-domain OCT. The clumped hyperreflective deposits in the outer retina may be by-products of RPE swelling and necrosis that lead to barrier dysfunctions and fluid leakage. These described features may help diagnose retinopathy from pregnancy-induced hypertension. Although it is a self-limited disease, the disruptions in the ellipsoid and interdigitation zones may not fully recover and result in reduced visual dysfunction. Therefore, control of hypertension is indicated.
妊娠高血压是孕妇特有的常见并发症,可导致视网膜病变。光学相干断层扫描(OCT)有助于发现眼底检查难以观察到的视网膜病变特征。并非所有患者的视网膜病变都能完全恢复。
本报告描述一例妊娠高血压合并视网膜病变的病例,并展示OCT和眼底荧光血管造影中视网膜病变的特征。
一名29岁孕妇在引产2天前出现双眼视力模糊和黄视;她在产科也被诊断为子痫前期。她右眼视力为20/33,左眼视力为20/20。眼底荧光血管造影显示早期视盘周围散在点状低荧光,双眼晚期荧光素渗漏时视盘附近逐渐出现针状高荧光。光学相干断层扫描显示视网膜多处浅层脱离,外层视网膜有高反射亮点,视网膜色素上皮(RPE)上有聚集的高反射物质。
通过光谱域OCT可以观察到外层视网膜和RPE的典型表现及一些微小变化。外层视网膜中聚集的高反射沉积物可能是RPE肿胀和坏死的副产物,导致屏障功能障碍和液体渗漏。这些所描述的特征可能有助于诊断妊娠高血压引起的视网膜病变。虽然这是一种自限性疾病,但椭圆体带和指状交叉带的破坏可能无法完全恢复,导致视力功能下降。因此,需要控制高血压。