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Madlene Holmqvist, Ingemar Gustafsson, Per Wollmer, Stefan Hansson, Patrik Schatz; Retinal Edema and Orbital Blood Flow in Preeclampsia. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3638.
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To investigate the frequency of retinal edema in patients with preeclampsia (PE) by Optical Coherence Tomography (OCT) and assess whether it correlates with orbital blood flow and the concentration of heme in cerebrospinal fluid (CSF), as a potential indicator of blood-brain and blood-retina barrier damage.
OCT was performed in a consecutive case series including 12 patients with PE. Eight healthy pregnant women served as controls. Doppler velocimetry of the ophthalmic artery (OA) and the central retinal artery (CRA) was performed pre- and post-delivery in 10 of the patients and in controls. CSF was collected from patients who underwent Caesarean section and heme concentration was determined by a colorimetric assay.
Two patients presented with subretinal fluid and cystoid macular edema, however orbital blood flow was not assessed. In the remaining patients retinal thickness and retinal nerve fiber layer thickness did not differ from controls. In the OA, median prenatal end diastolic flow (EDF) was 50 % higher (0.12 vs 0.08 m/s; p=0.004) and median prenatal vascular resistance (RI) was 11 % lower (0.71 vs 0.79; p=0.032) in PE patients compared to controls. In the CRA, median prenatal EDF was 35 % higher (0.027 vs 0.020 m/s; p=0.022) and RI was 12 % lower (0.63 vs 0.71; p=0.068) in PE women. In the OA there were no differences between the groups post-delivery but in the CRA median postnatal EDF was 48 % higher (0.034 vs 0.023 m/s; p=0.009) and RI was 14 % lower (0.61 vs 0.71; p=0.029) in PE women compared to the control group. Heme concentration in CSF was higher in women with PE compared to healthy pregnant women (median 7.19 and 4.43 μMolar, respectively).
Subclinical retinal or nerve fiber layer edema was not present in PE women although vascular orbital and retinal hyperperfusion and vasodilatation were demonstrated. The presence of heme in CSF may indicate damage to the blood brain barrier. PE may lead to a breakdown of the outer and inner blood-retina barrier, thus differing from central serous retinopathy were there is breakdown of only the outer blood-retina barrier. Our study warrants further assessment of ophthalmic examination as a potential quick and non-invasive routine tool in the management of PE.
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