Bilateral serous retinal detachment complicating preeclampsi
The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis may be related to the choroïdal ischemia secondary to arteriolar vasospasm. Published in the Indian Journal of Medical Specialities, the authors report a case of 36-year-old woman who developed severe preeclampsia in her first pregnancy with blurred vision secondary to bilateral serous retinal detachment.

A 36-year-old primiparous woman presented to the emergency at 34 weeks of gestation with headache and generalized edema and blurred vision in both eyes. Past medical history was unremarkable. General examination found high blood pressure at 220/130 mmHg, heart rate at 95 beats per minute (bpm), and fetal heart rate was 130 bpm. Dipstick urinary proteinuria was detected (3+), 24-h urinary protein was 1.9 g/l, and liver enzyme level was elevated.

The patient was hospitalized and a cesarean section was decided. By the first postpartum day, blood pressure returned to normal levels, and edema started regressing, but visual symptoms persisted. It was prescribed furosemide 40 mg/day, and she was kept at bed rest. Ophthalmologic examination found a visual acuity (VA) at 6/9 on the right eye and 6/30 on the left one. Anterior segment was normal. Fundus examination revealed bullous serous retinal detachment in both eyes.

Optical coherence tomography (OCT), an examination that shows images like almost histologic section of retina, confirmed retinal serous detachment with foveal uprising in the left eye. Acetazolamide per os was then started at 250 mg 3 times a day. Two weeks later, her VA had improved to 6/6 in both eyes. Fundus examination and macular OCT showed complete resorption of the retinal serous detachment.

Fluorescein angiography performed, one month postpartum, to look for choroidal sequelae such as choroidal ischemia that would be manifested by a delay and an irregular filling of choroidal vessels with fluorescein, and fluorescein diffusion through the vascular wall which reflects their hyper permeability; in this case, fluorescein angiography was normal, indicating complete recovery of choroidal blood flow. No ocular complications were found during six months follow-up.

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