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A Study of Ocular Fundus Findings in Hypertension during Pregnancy in a Tertiary Care Hospital


Affiliations
1 Former PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
2 Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
3 Senior Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
4 Professor and Head, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
 

Introduction: Hypertension is one of the most common medical disorders during pregnancy, affecting 6-8% of all pregnancies. Around 16-25% of 1st pregnancy &12-15% of subsequent pregnancies8 . Ocular fundus changes are found in 40% to 100% of pregnant women with raised blood pressure, whose severity correlates with pre-eclampsia or eclampsia. In hypertensive disorders in pregnancy, ophthalmic manifestations include conjunctival vasculopathy, hypertensive retinopathy, exudative retinal detachment, hypertensive choroidopathy. The retina is involved due to the basic pathology of vasospasm and increased capillary permeability, the consequences of vascular endothelial dysfunction. Rare complications were reversible cortical blindness, and extra-ocular muscle palsy have been documented. Methodology: The present study was conducted in the Outpatient Department (OPD) of Ophthalmology at Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik , Maharashtra. All the 182 cases included in this study underwent indirect ophthalmoscopy during the study period of 2 years (August 2018 to December 2020). Patients were collected from ANC clinic of department of obstetrics and Gynaecology OPD. Results: Prevalence of abnormal fundus findings was 10.1% in grade I hypertension while it was 100% in cases with grade II and III hypertension. A significant association was observed between severity of hypertension and abnormal fundus findings (p0.05). Conclusion: As these vascular changes in the retina usually correlate with the severity of the systemic hypertension, the eyes can truly be considered a mirror to the otherwise elusive vascular changes occurring elsewhere in the body. It thus stands to reason that observing the retinal changes holds the ability to prognosticate and also determine the severity of the disease. Fundoscopy is an essential investigation that needs to be done in all cases of hypertensive disorders of pregnancy with special emphasis in younger and primigravida women.

Keywords

Conjunctival Vasculopathy, Fundus, Hypertension, Ocular, Pregnancy
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  • A Study of Ocular Fundus Findings in Hypertension during Pregnancy in a Tertiary Care Hospital

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Authors

Chetan Gaikwad
Former PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
Ajit Khune
Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
Sanjay Mahadik
Senior Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India
Dhiraj Balwir
Professor and Head, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India

Abstract


Introduction: Hypertension is one of the most common medical disorders during pregnancy, affecting 6-8% of all pregnancies. Around 16-25% of 1st pregnancy &12-15% of subsequent pregnancies8 . Ocular fundus changes are found in 40% to 100% of pregnant women with raised blood pressure, whose severity correlates with pre-eclampsia or eclampsia. In hypertensive disorders in pregnancy, ophthalmic manifestations include conjunctival vasculopathy, hypertensive retinopathy, exudative retinal detachment, hypertensive choroidopathy. The retina is involved due to the basic pathology of vasospasm and increased capillary permeability, the consequences of vascular endothelial dysfunction. Rare complications were reversible cortical blindness, and extra-ocular muscle palsy have been documented. Methodology: The present study was conducted in the Outpatient Department (OPD) of Ophthalmology at Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik , Maharashtra. All the 182 cases included in this study underwent indirect ophthalmoscopy during the study period of 2 years (August 2018 to December 2020). Patients were collected from ANC clinic of department of obstetrics and Gynaecology OPD. Results: Prevalence of abnormal fundus findings was 10.1% in grade I hypertension while it was 100% in cases with grade II and III hypertension. A significant association was observed between severity of hypertension and abnormal fundus findings (p0.05). Conclusion: As these vascular changes in the retina usually correlate with the severity of the systemic hypertension, the eyes can truly be considered a mirror to the otherwise elusive vascular changes occurring elsewhere in the body. It thus stands to reason that observing the retinal changes holds the ability to prognosticate and also determine the severity of the disease. Fundoscopy is an essential investigation that needs to be done in all cases of hypertensive disorders of pregnancy with special emphasis in younger and primigravida women.

Keywords


Conjunctival Vasculopathy, Fundus, Hypertension, Ocular, Pregnancy

References