Bilateral exudative retinal detachment in eclampsia without hypertensive retinopathy

Area of Science:

• Ophthalmology
• Maternal-Fetal Medicine
• Vascular Biology

Background:

• Eclampsia, a severe complication of pregnancy, can manifest with various systemic and ocular findings.
• Retinal detachment, particularly bullous detachment, is a rare but serious ocular complication associated with eclampsia.
• The absence of hypertensive retinopathy in the presence of retinal detachment warrants further investigation into the underlying pathophysiology.

Observation:

• A patient presented with bilateral bullous retinal detachment attributed to pregnancy-induced eclampsia.
• Initial clinical examination revealed no signs of hypertensive retinopathy.
• Fluorescein angiography demonstrated normal retinal vasculature but widespread choroidopathy, suggesting a vascular origin for massive subretinal exudation.

Findings:

• The patient experienced rapid visual recovery with good visual acuity following the termination of pregnancy.
• Post-recovery, fluorescein angiography revealed residual diffuse fundus mottling.
• This mottling was attributed to pigment migration within the choroid and retinal pigment epithelium.

Implications:

• This case underscores the potential for significant ocular pathology, including bullous retinal detachment and choroidopathy, in eclampsia.
• The findings suggest that choroidal vascular compromise may play a crucial role in the pathogenesis of these ocular manifestations.
• Early consideration of pregnancy termination may be beneficial in cases of medically managed toxemia with persistent, unresponsive bullous retinal detachment.