ObjectiveTo observe and preliminary investigate the influencing factors of exudative retinal detachment in patients with severe preeclampsia (S-PE) and its influence on pregnancy outcome.MethodsA total of 89 patients of S-PE patients diagnosed in Department of Obstetrics in The Third Central Hospital of Tianjin from July 2018 to June 2020 were included in this study. According to whether the patients were complicated with exudative retinal detachment, they were divided into retinal detachment group (43 cases) and non retinal detachment group (46 cases). All patients underwent direct ophthalmoscopy, and those with suspected or definite retinal detachment underwent optical coherence tomography or B-mode ultrasonography. The age, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, laboratory serum albumin level, 24 h urinary protein, platelet count, mean platelet volume, platelet distribution width and serum uric acid content were collected. The average age (t=−1.01), body mass index (t=−1.799), course of disease (t=−1.657) and constituent ratio of primipara and multipara in the two groups were compared (χ2=1.411), the difference was not statistically significant (P＞0.05). The end of pregnancy time, systemic complications, fetal outcomes and neonatal Apgar scores were analyzed, retrospectively. Independent sample t test was used to compare the quantitative data between the two groups; Chi square test was used to compare qualitative data. Binary logistic regression analysis to screen the influencing factors of exudative retinal detachment in S-PE.ResultsSystolic blood pressure and diastolic blood pressure were higher in the retinal detachment group than in the non retinal detachment group, and the difference was statistically significant (t=2.087, 2.810; P=0.040, 0.006). Serum albumin (t=−10.404), 24-hour urinary protein quantification (t=6.401), blood uric acid (t=3.910), platelet count (t=−6.124) and platelet distribution width (t=2.992) were compared between the two groups, and the differences were statistically significant (P＜0.05). There were 30 (69.77%, 30/43) cases in retinal detachment group and 14 (30.43%, 14/46) cases in non retinal detachment group with severe systemic complications; The average time of ending pregnancy was 34.66±3.29 and 38.25±1.62 weeks; The average Apgar scores at birth were 7.28±3.40 and 9.46±1.59. The incidence of severe systemic complications in two groups (χ2=13.755), the end of pregnancy time (t=−6.448), Apgar score at birth (t=−3.824), the differences were statistically significant (P=0.000、0.000、0.000). Fetal distress and death were 8 (18.60%, 8/43), 7 (16.28%, 7/43) and 7 (15.22%, 7/46), 1 (2.17%, 1/46) in retinal detachment group and non retinal detachment group respectively. There was no significant difference in the incidence of fetal distress between the two groups (χ2=0.182, P=0.670). The difference of fetal mortality was statistically significant (P= 0.027). Logistic regression analysis showed that serum albumin and uric acid were associated with exudative retinal detachment in patients with S-PE (P＜0.05).ConclusionsSerum albumin and uric acid are the influencing factors of exudative retinal detachment in patients with S-PE. Patients with exudative retinal detachment are prone to adverse pregnancy outcomes.
ObjectiveTo observe and analyze the risk factors and optical coherence tomography (OCT) characteristics of exudative retinal detachment in patients with HELLP syndrome. MethodsA retrospective clinical study. From January 2015 to March 2021, 168 eyes of 84 patients with HELLP syndrome who were hospitalized in The Third Central Hospital of Tianjin were included in the study. The average age of the patients was 30.96±4.09 years old. The patient’s general clinical data which included age, gestational week of delivery, type of HELLP syndrome, onset time of HELLP syndrome, parity, number of pregnancy, systolic and diastolic blood pressure, total amount and duration of glucocorticoid, whether been admitted to intensive care unit; laboratory indicators, which included platelet count,serum albumin, serum uric acid, 24-hour urine protein quantification,aspartate aminotransferase, lactate dehydrogenase, total bilirubin (TBIL) were collected. Whose the general condition was not allowed, however patients had a complaint of vision loss or suspected retinal detachment under direct ophthalmoscope examination, B-mode ultrasound was used to assist in the diagnosis. According to the presence or absence of exudative retinal detachment, patients were divided into retinal detachment group (net detachment group) and non-retinal detachment group (non-retinal detachment group), respectively 31 (36.90%, 31/84), 53 (63.10%, 53/84) cases. Among the 31 cases in the network disconnection group, 34 eyes in 17 cases underwent OCT. Two independent sample t tests were used to compare the measurement data of normal distribution between groups, Wilcoxon rank sum test was used to compare skewed distributions; the χ2 test was used to compare count data. The variables with statistical differences in univariate analysis were selected as independent variables, and binary logistic regression analysis was performed. ResultsAmong 84 patients, HELLP syndrome was classified into partial type and complete type, 41 (48.81%, 41/84) and 43 (51.19%, 43/84) cases, respectively. Compared with the non-net-off group, the patients in the off-line group had shorter gestational weeks (t=2.51), higher diastolic blood pressure (t=−2.61), greater total glucocorticoid use (Z=−2.14), and longer use time of glucocorticoid (Z=−2.75), the difference were statistically significant (P＜0.05); TBIL (Z=−2.49), serum albumin (t=2.06) levels decreased, and 24-hour urine protein quantitative (Z=−4.35) levels increased, the difference were statistically significant (P＜0.05). Logistic regression analysis showed that the increase of 24-hour urine protein level increased the risk of exudative retinal detachment (P＜0.05) (odds ratio=1.20, 95% confidence interval 1.06-1.37). Among the 34 eyes that underwent OCT examination, 18 eyes showed that the retinal pigment epithelium (RPE) layer was not smooth, thickened, and seemed to have adhesion to the detached retina. After the reattachment of retinal detachment, the above-mentioned changes of RPE still existed, but reduced; the ellipsoid zone still has discontinuity, partial rupture, and even extensive loss in 16 eyes. ConclusionThe quantitative increase of 24-hour urine protein is a risk factor for the occurrence of exudative retinal detachment in HELLP syndrome; some patients with exudative retinal detachment are still missing the ellipsoid zone after reattachment.