Ocular changes in preeclampsia

Abstract The pregnancy is associated with modifications involving multiple systems and organs, including the eye. The retinal vascular changes are present in 30-100% of the PE cases. The most frequent ocular modification is the vasoconstriction of the retinal arterioles. The exudative retinal detachment is a rare cause (under 1%) of visual loss in the PE-E syndrome, being produced by the involvement of the choroidal vascularization. Most cases of blindness during pregnancy have been determined by cortical, occipital anomalies, the used terminology in these circumstances being cortical blindness. The pathogenesis of the Purtscher retinopathy is the embolism of the retinal arterioles, by leucocytic aggregation, as a response to the activation of the complement. The evaluation of the ophthalmic arterial flow by eco Doppler might offer new perspectives regarding the understanding of the physiopathology, the diagnosis and the quantification of the PE severity. The decrease of the IP values and the increase of the median velocity in the ophthalmic artery in pregnant women with PE, suggest a hyperperfusion process and the decrease of the vascular resistances at the level of the orbital vessels, but also in the CNS. In the severe forms of PE, the increase of the impedance of the orbital vessels has been noted. The described vascular changes cannot disappear completely 6 weeks after birth; a residual arteriolar constriction might persist, as a permanent stigma of the PE. The evaluation, monitoring, therapeutical approach of the patients with PE must be performed by a complete team: obstetrician, ophthalmologist, neurologist, radiologist, in order to decrease the materno-fetal risks and improve the prognosis of PE.