ObjectiveTo observe and analyze the fundus of pregnancy-induced hypertension syndrome (PIHS) and optical coherence tomography (OCT) characteristics and its correlation with ocular symptoms and degree of the systemic disease. MethodsA total of 132 PIHS patients (264 eyes) received the examinations of corrected visual acuity, slit lamp microscope, direct ophthalmoscope, OCT and fundus color photography after obtaining informed consent in the study. There were 10 cases of gestational hypertension, 29 cases of preeclampsia (mild), 82 cases of pre-eclampsia (severe) and 11 cases of eclampsia. 91 patients (180 eyes) felt blurred vision and visual fatigue. 102 patients were examined at an average gestational age of (37.00±2.14) weeks and 30 patients were examined at an average (10.00±8.22) days postpartum. The ocular fundus was divided into normal fundus and abnormal fundus; the abnormal fundus had 3 stages, including stageⅠ(retinal arterial spasm), stageⅡ(retinal arteriosclerosis) and stageⅢ(retinopathy). If the OCT results seems to be abnormal, these patients were further selected to observe the changes of neurosensory serous retinal detachment, retinal pigment epithelium (RPE) and junction of inner and outer segment of photoreceptor (IS/OS). Kappa test was used to analyze the consistency between fundus performance and OCT results, and that of ocular symptoms with fundus changes and OCT results. Rank correlation test was used to analyze the degree of PIHS and OCT examinations. ResultsThere were 32 eyes with normal fundus (12.12%) and 232 eyes with abnormal fundus (87.88%). The 232 eyes with abnormal fundus were divided into three stages: stageⅠfor 16 eyes (6.90%), stageⅡfor 31 eyes (13.36%) and stageⅢfor 185 eyes (79.74%). 92 of 264 eyes (34.85%) had normal OCT findings, 172 eyes (65.15%) were abnormal, including 94 eyes with serous retinal neurosensory detachment (54.65%), 40 eyes with changes of RPE and IS/OS (23.26%) and 38 eyes with other manifestations (22.09%). Kappa test analysis showed highly consistency between OCT results and ocular symptoms (K=0.728, Po=0.591), and poor consistency between fundus abnormalities and ocular symptoms (K=-0.129, Po=0.879), and between fundus abnormalities and OCT results (K=0.174, Po=0.682). OCT results were positively correlated with the degree of PIHS (C=0.374, χ2=74.011; P=0.000). Conclusions87.88% of PIHS eyes had various degrees of retinal hemorrhage, cotton wool spots, retinal bumps or detachment, optic disc edema and other retinal abnormalities. 65.15% of that showed OCT abnormal results such as neurosensory retinal detachment, cystoid edema, RPE changes etc. The consistency was poor between the OCT results and fundus abnormalities. OCT results are positively correlated with the degree of PIHS.
ObjectiveTo observe the image characteristics of multispectral scanning laser imaging (MSLI) and OCT in patients with pregnancy induced hypertension syndrome (PIHS).MethodsA total of 112 patients (224 eyes) of PIHS patients diagnosed in Obstetrics Department of Tianjin First Central Hospital from May 2016 to May 2017 were included in this study. The average age of the patients was 27.00±2.14 years. The average course of the disease was 15.00±8.27 days. There were 174 eyes in 87 patients of blurred vision, dazzling and visual fatigue consciously. All patients performed BCVA, direct ophthalmoscope, B ultrasound, confocal scanning laser Ophthalmoscope (cSLO) and spectral-domain OCT (SD-OCT). SD-OCT was performed with Spectralis HRA+OCT from Heidelberg Company in Germany to acquire tomographic images. Using Herdelberg's colorful program (MultiColor) based on cSLO and operating in accordance with standard methods, one scan simultaneously obtained blue light reflection based on 488 nm, green light reflection based on 515 nm, and infrared reflection based on 820 nm, synthesis to MSLI. Fundus abnormalities were classified into arterial spasm (stage Ⅰ), arteriosclerosis (stage Ⅱ), and retinopathy (stage Ⅲ). OCT examination was divided into normal and abnormal cases according to the abnormality of retinal morphology and thickness.ResultsOf the 224 eyes, 68 eyes (30.36%) showed normal fundus examination and 156 eyes (69.64%) showed abnormal fundus performance. Among them, 28 eyes were stage Ⅰ (17.95%); 40 eyes were stage Ⅱ (25.64%); 88 eyes were stage Ⅲ (56.41%). Thirty-six eyes (16.07%) showed normal fundus and 188 eyes (83.93%) showed abnormal performance with OCT. Of the 188 eyes with abnormal fundus performance, 86 eyes (45.74%) had retinal neuroepithelial serous detachment; 56 eyes (29.79%) had RPE detachment; optic disc edema, bulge, and local reflexes in the retinal nerve fiber layer were enhanced and/or the thickness increased in 46 eyes (24.47%). In MSLI, 48 eyes (21.43%) showed normal fundus; 176 eyes (78.57%) showed abnormal performance. Retinal edema was showed in green on MSLI, serous retinal neuroepithelial layer detachment, RPE layer detachment, retinal nerve fiber layer thickening, accompanied by changes in local retinal structure. The higher the degree of bulge, the darker the color. Consistent with the range of retinal edema revealed by SD-OCT.ConclusionsMSLI and SD-OCT images show highly consistent lesions in PIHS patients. MSLI can more clearly show superficial and deep retinal lesions.
ObjectiveTo observe the changes of macular vascular density of hypertensive patients without obvious hypertensive retinopathy (HRP).MethodsTwenty-three patients (hypertension group) diagnosed as grade 2 or grade 3 essential hypertension in Cardiology Department of Renmin Hospital of Wuhan University from January to April 2019 were enrolled in the study. Among them, there were 13 males and 10 females. The mean age was 61.6 ± 5.6 years, and the mean BCVA was 0.74 ± 0.16. The course of hypertension was more than 7 years; Keith Wagener (K-W) grade was 0 or 1. Fifteen age-matched people without hypertension were selected as the control group, among which included 8 males and 7 females. Their average age was 59.7 ± 4.4 years and the average BCVA was 0.79 ± 0.17, the K-W grades were 0. There was no significant difference (P=0.265, 1.000, 0.563) between the two groups in age (t=1.739), sex ratio (χ2=0.036) or BCVA (t=0.585). All subjects were examined by BCVA, fundus photography and OCTA. OCTA scanned the macular area in the range of 3 mm × 3 mm. The software automatically divided the image into two concentric circles with the macular fovea as the center, which are the inner ring with a diameter of 1 mm (foveal area) and the outer ring with a diameter of 1-3 mm. The blood flow density of the whole, temporal, upper, nasal and lower capillary layers within 3 mm of the macular area, and foveal avascular zone (FAZ) area, central foveal retinal thickness (CFT) were measured.ResultsSignificant differences were observed in the vascular densities of total, temporal, nasal and inferior area of maculas (t=2.188, 2.472, 5.105, 2.734; P=0.037, 0.020, 0.000, 0.010) between the two groups, while no significant differences were evidenced in foveal vascular densities and superior vascular densities (t=0.575, 0.140; P=0.570, 0.889). There was no significant difference in FAZ area or CFT between the two groups (t=0.367, 0.753; P=0.714, 0.457). Macular arches were intact in all hypertension patients.ConclusionsThe vascular densities of total, temporal, nasal and inferior area of maculas in the hypertension patients without HRP decreased. The area of FAZ did not expand, and the structures of macular arch ring were normal.
ObjectiveTo observe and analyze the risk factors of retinopathy in patients with hypertension in pregnancy.MethodsA retrospective clinical study. From January 2018 to December 2019, 260 patients with hypertension during pregnancy who were hospitalized in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University were included in the study. All patients underwent fundus color photography examination. Their age, gestational age, course of hypertension, past history, number of pregnancy and childbirth, pre-pregnancy body mass index (BMI) and laboratory blood routine, alanine aminotransferase, aspartate aminotransferase, and urea Nitrogen, creatinine, uric acid, serum albumin concentration, and 24-hour urine protein concentration and urine protein content examination results were collected. Among the 260 patients, there were 60 and 200 patients with or without retinopathy in the fundus, respectively. Patients were divided into retinopathy group and no retinopathy group. The comparison of quantitative data between groups was performed by independent sample t test; the comparison of grade data was performed by Mann-Whitney U nonparametric test. The variable with statistical difference between the two groups was the independent variable, and the two-class logistic regression analysis was performed.ResultsGestational week (t=4.875), pre-pregnancy BMI (t=2.779), highest systolic blood pressure (t=－4.799), lowest systolic blood pressure (t=－4.797), highest diastolic blood pressure (t=－4.226), minimum diastolic blood pressure (t=－4.226), low and high platelet values and their fluctuations (t=7.701, 2.504, －6.083), serum albumin concentration (t=13.255), aspartic acid transaminase (t=－2.272), urea nitrogen (t=－5.117), creatinine (t=－2.735), uric acid (t=－2.130), 24-hour urine protein concentration (t=－7.801) and 24-hour urine protein (t=－7.567) were compared. The difference was statistically significant (P＜0.05). Logoistic regression analysis showed that pre-pregnancy BMI, maximum systolic blood pressure, low platelet value, and serum albumin were related to the occurrence of retinopathy of hypertension in pregnancy (P＜0.05).ConclusionHigh systolic blood pressure, low platelets, and low serum albumin are the risk factors for the occurrence of retinopathy of hypertension in pregnancy.