Retina and Vitreous

Choroidal ischemia has been proposed as the factor precipitating serous detachments of the retina in preeclamptic patients. Fluorescein angiography has shown patchy choroidal filling and Elshnig's spots with normal retinal vasculature. The authors performed FA and Indocyanine Green (ICG) Angiography on 4 preeclamptic patients who suffered decreased vision within days of parturition to evaluate the choroidal circulation. No pregnant patients were enrolled to eliminate any potential side effects to the fetus. All mothers were instructed not to breast feed for 48 hours after the test.

The ICG studies showed:

1. Early patchy choroidal filling/choroidal non-perfusion.
2. Pinpoint hyperfluorescence at the RPE level which leak.
3. Retinal vasculature without leakage.
4. Leakage from small AND medium sized choroidal vessles with late hyperfluorescence, ie. staining.

The authors demonstrate that retinal complications in preeclampsia (and eclampsia) result from small and medium-sized choroidal vascular damage, in addition to the choriocapillaris as suggested in previous studies. They conclude this damage leads to RPE compromise and subsequent subretinal pooling of fluid which originates in the choroidal vessels resulting in serous detachments.

Raymond Magauran, MD
West Bloomfield, MI

Retina and Vitreous

Vascular endothelial growth factor (VEGF) levels have previously been linked to iris, optic disk and retinal neovascularization. This paper shows that VEGF vitreous levels similar to those in eyes with neovascularization can cause intraretinal changes. These changes mirror ischemic retinal findings including hemorrhage, microaneurysms, venous beading, edema and neovascularization. The veins were affected more than the arteries. Extraretinal neovascularization did not occur in any of the VEGF eyes. Future anti-VEGF medications could play a role in altering the poor prognosis of such devasting eye diseases.

Raymond G. Magauran, M.D.
Kresge Eye Institute,
Detroit, Michigan