Ocular Manifestations of Preeclampsia and Eclampsia among Pregnant Women Admitted at Muhimbili National Hospital, Dar es Salaam, 2014

Abstract

Background: Pre-eclampsia and eclampsia are pregnancy related complications having various effects in different organs and systems. Cardiovascular changes, hematologic abnormalities, hepatic and renal impairment, neurologic and ophthalmic manifestations have all been implicated in pre-eclampsia and eclampsia. Pre-eclampsia and eclampsia can affect the visual pathways, from the anterior segment to the visual cortex. Visual symptoms are reported in up to 25% of patients with severe preeclampsia and 50% of patients with eclampsia. Many studies done in developed countries have reported various findings such as retinal hemorrhages, cotton wool spots, retinal arteriolar narrowing, exudative retinal detachment, cortical blindness, retinal pigment epithelium lesions like Elschnig’s spots and vascular occlusive pathologies. In Tanzania, there are no published studies about the subject. This prompted the need to conduct this study.

Broad objective: To determine the prevalence and causes of visual impairment in patients with pre-eclampsia and eclampsia admitted at Muhimbili National Hospital, Dar es Salaam.

Methodology: This was a hospital-based prospective cross-sectional study that was conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania between May and December 2014. Convenient sampling method was used. Preliminary data was obtained from patients or patients’ files and registers at the eclampsia unit. Ocular examination was done by the researcher and the findings were recorded in the questionnaires. Data was entered into a computer using EPI info version 7.0. Analysis was done by SPSS version 20.0 software.

Results: One hundred thirteen patients were recruited and all were included in the analysis. The age range was 18–49 years, with a mean age of 29.26 years.The study population constituted 45(39.8%) patients with pre-eclampsia, 27(23.9%) eclampsia, 35(31%) severe preeclampsia and 6(5.3%) post-partum eclampsia. Poor vision 39(35.4%)was the most common visual symptom. Other ocular complaints included; photopsia 18(15.9%), diplopia 3(2.7%), photophobia 1(0.9%) and ocular pain 1(0.9%). Papilledema 32(28.3%) was the most common fundus finding among patients with pre-eclampsia and eclampsia followed by retinal edema 22(19.5%), cotton wool spots 21(18.6%), arteriolar narrowing 20(17.7%), flame-shaped hemorrhage 9(8%), temporal disc pallor 9(8%), macular edema 6(5.3%), arterioveinous nipping 5(4.4%) and exudative retinal detachment 1(0.9%).Visual impairment was temporary and time of visual recovery varried among the patients. Thirty nine patients (35.4%) had best corrected visual acuity <6/18 on admission. The visual acuity of most patients improved and there were only 15(13.3%) with the BCVA<6/18 at discharge. This finding was statistically significant (p<0.001). The mean visual recovery time was 8.5±1.2 days. Conclusion: The magnitude of ocular complications among mothers with pre-eclampsia and eclampsia is significantly high. The most common ocular manifestation is poor vision due to macular edema, retinal edema, optic neuropathy, cortical blindness and exudative retinal detachment. Poor vision is associated with severity of the disease and is temporary in majority of cases. Recommendation: Health care providers should be aware that sudden onset of visual symptoms in pregnant women can be an alarming sign of pre-eclampsia and eclampsia. Obstetricians should include in their practice, fundus examination in mothers with pre-eclampsia and eclampsia and discuss other diagnostic options and management if needed, with the ophthalmologist. A system to follow up patients with pre-eclampsia and eclampsia after discharge for visual evaluation and appropriate management be established at MNH. Efforts to educate patients to seek immediate obstetric care if they experience sudden onset of visual symptoms is important.