Advancing pregnancy induces obvious physical changes for women over time. However, numerous not-so-obvious physiologic, hormonal, and metabolic changes also occur during pregnancy of which ophthalmologists should make themselves aware. Some of these changes include: increased serum cortisol, increases in blood pressure during the third trimester, increased blood volume, insulin resistance with worsening glycemic control, and hypercoagulability.
Considering these complications, pregnancy might induce certain retinal and choroidal diseases, such as hypertensive retinopathy and choroidopathy, exudative retinal detachment, and retinal vascular occlusive diseases, as well as exacerbate other diseases, according to Mark Johnson, MD, and Julie M. Rosenthal, MD.
Hypertensive retinopathies and choroidopathies that might develop are the pregnancy-induced hypertension (PIH) syndromes of preeclampsia and eclampsia. The former includes hypertension, peripheral edema, and proteinuria, and the latter is defined as pre-eclampsia plus seizures.
The fundus findings associated with the PIH syndromes that ophthalmologists should be alerted are arteriolar constriction, retinal hemorrhages, cotton-wool spots, retinal edema, and lipid exudates; the presence of subretinal fluid (choriocapillaris infarction); and optic disc edema and/or ischemia.
Dr. Johnson, professor of ophthalmology and visual science, University of Michigan Kellogg Eye Center, Ann Arbor, recounted the case of a 41-year-old woman who presented with a three-day history of blurred vision, back pain, and hypertension late in the third trimester.
Her visual acuity levels were 20/100 and 20/400 in the right and left eyes, respectively. After the patient underwent a C-section, the visual acuity levels and the fundus findings returned to normal. In pregnant patients who develop an exudative retinal detachment, physicians should consider the presence of the HELLP syndrome [Hemolysis, Elevated Liver enzymes, Low Platelets], which is a life-threatening liver disorder.