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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 3  |  Page : 268-270

A study on changes in choroidal thickness in antenatal women with pregnancy-induced hypertension using spectral-domain-optical coherence tomography


Department of Ophthalmology, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India

Date of Submission21-Mar-2020
Date of Acceptance28-Mar-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Dr. Venkatesh Perumal
Department of Ophthalmology, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_34_20

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  Abstract 


Aim: To evaluate the choroidal thickness using spectral-domain optical coherence tomography (SD-OCT) in antenatal women with pregnancy induced hypertension. Methods and Material: In this observational study 100 eyes of 50 pregnant women with pregnancy induced hypertension were included and compared with age matched non- pregnant women. Retinal SD OCT scan was done. The choroidal thickness at the fovea, 500 μm nasal and temporal to the fovea were measured manually. Statistical analysis used: Unpaired T test was used. Results: The mean choroidal thickness in pregnant women with PIH was 346.23 μm and in normal non-pregnant women it was 296.16 μm. In Multigravida with PIH (317.91 μm) the choroidal thickness was found to be less when compared with primigravida with PIH(359.53). All these results were statically significant. Conclusions: This study revealed that there was increase in choroidal thickness in pregnant women with PIH when compared to non-pregnant women. However there was a significant decrease in choroidal thickness in multigravida women with history of PIH and also the thickness of choroid decreased with increase in age.Further studies are needed to correlate choroidal blood flow and choroidal thickness in PIH mother.

Keywords: Choroidal thickness, optical coherence tomography, pregnancyinduced hypertension


How to cite this article:
Subramaniyan S, Perumal V, Thenmozhi R. A study on changes in choroidal thickness in antenatal women with pregnancy-induced hypertension using spectral-domain-optical coherence tomography. Kerala J Ophthalmol 2020;32:268-70

How to cite this URL:
Subramaniyan S, Perumal V, Thenmozhi R. A study on changes in choroidal thickness in antenatal women with pregnancy-induced hypertension using spectral-domain-optical coherence tomography. Kerala J Ophthalmol [serial online] 2020 [cited 2021 Apr 22];32:268-70. Available from: http://www.kjophthal.com/text.asp?2020/32/3/268/304551




  Introduction Top


Pregnancy-induced hypertension (PIH) and its complications are one of the leading causes of maternal mortality and morbidity worldwide. It complicates approximately 5%–7% of all pregnancies. The pathological changes in PIH are related to vascular endothelial dysfunction, increased systemic vascular resistance, and capillary leak. 40% of PIH patients have some visual disturbances. The most common Changes in the eye include narrowing of retinal arterioles, exudates, retinal edema, anterior ischemic optic neuropathy, transient blindness due to arteriolar spasm, cortical blindness, central serous retinopathy (CSR), Purtscher's-like retinopathy, and retinal and vitreous hemorrhages.[1],[2],[3]

The photoreceptors are supplied by choroidal vasculature which is responsive to vascular endothelial growth factor (VEGF), which is upregulated in PIH. Acute vasospasm results in a thickened, edematous choroid as compared to normotensive pregnant women.[4] Optical coherence tomography (OCT) is a new noninvasive, rapid, objective, retinal imaging modality that provides high-resolution, cross-sectional images of the retina and choroid with a longitudinal resolution of 3-10 μm. This study aims to assess the changes in choroidal thickness in PIH using OCT.[5],[6],[7]


  Subjects and Methods Top


One hundred eyes of 50 pregnant women with PIH, preeclampsia, and eclampsia were included in this study and compared with age-matched nonpregnant women. Patients with high refractive errors, hypertension, diabetes, Central Serous Chorioretinopathy, or any other retinal pathology involving the macula were excluded from this study. OCT was taken using spectral-domain-OCT. Radial and line protocol scans were taken. Choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border at the fovea, and 500 μm nasal and temporal to the fovea. The choroidal thickness measurement was done Manually [Figure 1].
Figure 1: Choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border at the fovea, and 500 μm nasal and temporal to the fovea

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  Results Top


The mean choroidal thickness in pregnant women with PIH was 346.23 μm [Table 1]. It was 346.58 μm, at the fovea, 342.33 μm nasal to the fovea, and 349.79 μm temporal to the fovea [Table 2]. The choroidal thickness in pregnant women with PIH was significantly increased when compared to the choroidal thickness of nonpregnant women (296.16 μm).[8]
Table 1: Mean choroidal thickness of women with pregnancy-induced hypertension and nonpregnant women

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Table 2: Mean choroidal thickness in pregnancy-induced hypertension women

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There was a significant decrease in choroidal thickness in multigravida women with PIH (317.91 μm) when compared to Primigravida with PIH (359.53 μm) [Table 3]. Choroidal thickness in patients with recently diagnosed PIH was 348.14 μm, and it was 342.28 μm in PIH women on treatment [Table 4].
Table 3: Mean choroidal thickness in multigravida and primigravida - pregnancy-induced hypertension

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Table 4: Mean choroidal thickness of newly diagnosed pregnancy-induced hypertension and pregnancy-induced hypertension women on treatmen

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Choroidal thickness decreased with increasing age in PIH women. The choroidal thickness being 351.59 μm in age <20 years, 345.93 μm at 20–30 years, and 327.50 μm >30 years [Table 5].
Table 5: Mean choroidal thickness with increasing age

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  Discussion Top


PIH is the development of increase in blood pressure after 20 weeks of gestation in a woman with previously normal blood pressure. In a normal pregnancy, blood volume and erythrocyte count increases, physiological anemia occur, blood pressure drops, and there is an increase in cardiac blood flow and volume, causing an increase in ocular blood flow. Pregnancy is associated with ocular changes that may be physiological or pathological, and these are mostly transient and revert to normal but sometimes can become permanent. PIH is due to abnormal placentation resulting in increased systemic vascular resistance and generalized vasospasm in multiple organs including ocular vasculature. Choroid, which receives 65%–85% of the ocular blood flow, is important for normal functioning of the outer neuroretinal layer.[9]

It has been reported in studies that choroidal thickness in PIH was significantly thicker than healthy nonpregnant women.[10] It is mostly due to an increase in fluid retention in the choroidal layer during pregnancy. However, the choroidal thickness in PIH is low when compared with healthy pregnant women.[11] This decrease in choroidal thickness in pregnant women with PIH is due to increased vasospasm secondary to PIH. Maynard et al.[12] described that this is due to high concentration of placental soluble FMS-like tyrosine kinase 1 (VEGF inhibitor) that causes vasospasm and hypertension in PIH.

In this study, choroidal thickness was evaluated to assess the changes in this vascular layer. Choroidal thickness was measured at the fovea, nasal to the fovea, and temporal to fovea and was compared with age-matched nonpregnant women.

The mean choroidal thickness was 346.58 μm, at the fovea, 342.33 μm nasal to the fovea, and 349.79 μm temporal to the fovea. This was similar to the results of studies by Bhayana et al.[13] and Narendran et al.[14] where the choroidal thickness was higher temporally.

The mean choroidal thickness in pregnant women with PIH was 346.23 μm, and the mean choroidal thickness in healthy nonpregnant women was 296.16 μm, which is statistically significant (P = 0.02). Ataş et al.[15] and Garg et al.,[7] also reported an increase in choroidal thickness in their studies.

The choroidal thickness in multigravida women with PIH was 317.91.μm, which is less when compared to primigravida women with PIH (359.53 μm). This has not been reported in earlier studies.

There was a decrease in the choroidal thickness with age from 351.59 μm at <20 years to 327.50 μm in mothers >30 years, which was similar to the studies by Margolis and Spaide[16] who reported a 15.6 μm decrease in CT every 10 years, and Ikuno et al.[17] showed a decrease of 14 μm for every 10 years.


  Conclusion Top


This study revealed that there was an increase in choroidal thickness in pregnant women with PIH when compared to nonpregnant women. However, there was a significant decrease in choroidal thickness in multigravida women with PIH, and also the thickness of choroid decreased with increase in age. Further studies are needed to correlate choroidal blood flow and choroidal thickness in PIH women.

Limitation

In this study, the choroidal thickness in 2nd trimester was not evaluated. This being a tertiary care hospital, most of the patients were admitted for safe confinement in 3rd trimester and admissions were few in 2nd trimister. Evaluation of choroidal thickness in 2nd trimester would help to further understand the pathophysiological changes in the choroid in PIH.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Akhtar Z, Rishi P, Srikanth R, Rishi E, Bhende M, Raman R. Choroidal thickness in normal Indian subjects using Swept source optical coherence tomography. PLoS One 2018;13:e0197457.  Back to cited text no. 1
    
2.
Rahman W, Chen FK, Yeoh J, Patel P, Tufail A, Da Cruz L. Repeatability of manual subfoveal choroidal thickness measurements in healthy subjects using the technique of enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 2011;52:2267-71.  Back to cited text no. 2
    
3.
Maynard SE, Sukhatme VP, Karumanachi SA. Excess placental soluble FMS-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension and proteiunria in preeclampsia. J Clin Invest 2003;111:649-58.  Back to cited text no. 3
    
4.
Duru N, Ulusoy DM, Özköse A, Ataş M, Karatepe AS, Ataş F, et al. Choroidal changes in pre-eclampsia during pregnancy and the postpartum period: Comparison with healthy pregnancy. Arq Bras Oftalmol 2016;79:143-6.  Back to cited text no. 4
    
5.
Bakhda RN. Ocular manifestations of pregnancy induced hypertension. DJO 2015:26:88-92.  Back to cited text no. 5
    
6.
Reddy SC, Nalliah S, George SR, Who TS. Fundus changes in pregnancy induced hypertension. Int J Ophthalmol 2012;5:694-7.  Back to cited text no. 6
    
7.
Garg A, Wapner RJ, Ananth CV, Dale E, Tsang SH, Lee W, et al. Choroidal and retinal thickening in severe preeclampsia. Invest Ophthalmol Vis Sci 2014;55:5723-9.  Back to cited text no. 7
    
8.
Sheth BP, Mieler WF. Ocular complications of pregnancy. Curr Opin Ophthalmol 2001;12:455-63.  Back to cited text no. 8
    
9.
Liu R, Kuang GP, Luo DX, Lu XH. Choroidal thickness in pregnantwomen: A cross-sectional study. Int J Ophthalmol 2016;9:1200-6.  Back to cited text no. 9
    
10.
Peiretti E, Zhang J, Wang H, Yu Q, Tong Q, Lu Q. Enhanced depth imaging optical coherence tomography: A new way measuring choroidal thickness in pregnant women. Journal of Ophthalmology 2017:1–9.  Back to cited text no. 10
    
11.
Dadaci Z, Alptekin H, Oncel Acir N, Borazan M. Changes in choroidal thickness during pregnancydetected by enhanced depth imaging opticalcoherence tomography. Br J Ophthalmol 2015;99:1255-9.  Back to cited text no. 11
    
12.
Benfica CZ, Zanella T, Farias LB, Oppermann ML, Canani LH, Lavinsky D. Choroidal thickness in preeclampsia measured by spectral-domain optical coherence tomography. Int Ophthalmol 2019;39:2069-76.  Back to cited text no. 12
    
13.
Ataş M, Açmaz G, Aksoy H, Demircan S, Ataş F, Gülhan A, et al. Evaluation of the macula, retinal nerve fiber layer and choroid in preeclampsia, healthy pregnant and healthy non-pregnant women using spectral-domain optical coherence tomography. Hypertens Pregnancy 2014;33:299-310.  Back to cited text no. 13
    
14.
Margolis R, Spaide RF. A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 2009;147:811-5.  Back to cited text no. 14
    
15.
Ikuno Y, Kawaguchi K, Nouchi T, Yasuno Y. Choroidal thickness in healthy Japanese subjects. Invest Ophthalmol Vis Sci 2010;51:2173-6.  Back to cited text no. 15
    
16.
Bhayana AA, Kumar V, Tayade A, Chandra M, Chandra P, Kumar A. Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography. Indian J Ophthalmol 2019;67:252-5.  Back to cited text no. 16
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17.
Narendran S, Manayath G, Venkatapathy N. Comparison of choroidal thickness using swept-source and spectral-domain optical coherence tomography in normal Indian eyes. Oman J Ophthalmol 2018;11:38-41.  Back to cited text no. 17
[PUBMED]  [Full text]  


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Subjects and Methods
Results
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