Retinal pigment epithelial lesions associated with choroidal ischemia in preeclampsia

Retinal and choroidal changes are considered uncommon ocular complications in preeclampsia. The authors evaluated preeclamptic and eclamptic patients to clarify the ophthalmologic features of preeclampsia.

The records of 71 women with severe preeclampsia or eclampsia were reviewed. Lesions related to choroidal circulatory disturbance were identified on review of patient fundus examinations and fluorescein angiograms.

Of 31 women whose records were evaluated, serous retinal detachments, yellowish, opaque retinal pigment epithelium (RPE) lesions, or both were present in 47 eyes (both lesions in 29 eyes, RPE lesions alone in 7 eyes, and serous retinal detachments alone in 11 eyes). Of the 36 eyes with RPE lesions, 33 (92%) had solitary or grouped lesions and 3 (8%) had large geographic lesions. The lesions were most commonly observed in the peripapillary area and macula. Lesions resolved without scarring in 3 weeks in 30 (83%) of these eyes. There was residual pigmentary mottling in three eyes (8.5%); in an additional three eyes (8.5%), all of which had had geographic lesions, significant chorioretinal atrophy developed.

The results suggest that the incidence of RPE lesions and serous retinal detachments, which are transient manifestations of choroidal ischemia, is high in patients with severe preeclampsia and eclampsia. These conditions resulted in significant scarring in only a small number of patients.