Dear editor,
We read with great interest the article entitled “Serious visual (ocular) complications in pre-eclampsia and eclampsia” recently published by Radha Bai Prabhu [1] in The Journal of Obstetrics and Gynecology of India. In this study the author described the incidence and the clinical course of blindness in women with eclampsia and pre-eclampsia over a 4-year period follow-up and found the presence of visual loss in 16/9199 patients (0.17%), including 14 cases of cortical blindness and 2 retinal detachments [1].
The author should be congratulated for the prospective long-term design of the study, for having evaluated a large sample size of women and, nonetheless, for the multidisciplinary work with other specialists such as neurologists and ophthalmologists.
However, we would like to point out some methodological concerns about the findings in this study from an ophthalmological point of view. Firstly, the author did not specify if, beside the funduscopy, the comprehensive ophthalmological examination included also multifocal electroretinography, optical coherence tomography (OCT) and fluorescein angiography, all diagnostic tools that have shown to better characterize ocular complications in (pre-eclamptic women) [2]. In a prospective study published in retina by Neudorfer et al., the authors examined retinal findings in a sample of pre-eclamptic women and demonstrated that the retinal nerve fibre layer (RFLN) thickness measured by OCT was significantly thicker in women with abnormal retinal findings in comparison with those with normal findings detected by slit-lamp examination [3]. Thus, OCT would provide a more detailed quantitative tool in the evaluation and follow-up of the neurological damage caused by (pre-)eclampsia in comparison with simple funduscopy.
Secondly, in this study only 2/9199 cases of serous retina detachments were reported by the author, providing a very small incidence of the disease in (pre-)eclamptic women [1]. However, other studies have reported higher incidence rates of retinal detachment in these patients; In fact, Schultz et al. described an incidence rate of 1% in patients with pre-eclampsia and even 10% in eclamptic women [4]. Moreover, Saito et al. found investigating 71 women with severe pre-eclampsia/eclampsia that the prevalence of serous retinal detachment was 32% [5].
Hence, given the conflicting findings on the incidence of retinal detachment in (pre-)eclamptic women, further larger-scale studies with complete eye examination should be performed, in order to provide more reliable results dealing with the association between (pre-)eclampsia and retinal detachment.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Footnotes
Lorenzo Ferro Desideri, MD., Research fellow at the University of Genoa, postgraduate intern at the Department of Ophthalmology, University of Genoa; Fabio Barra, MD., postgraduate intern at the Department of Gynecology and Obstetrics, University of Genoa; Simone Ferrero, MD., PhD., Associate Professor of Gynecology and Obstetrics, University of Genoa.
References
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