Ocular sonographic manifestations among pre-eclamptic women at Kawempe National Referral Hospital

Abstract

Pre-eclampsia (PE) is a pregnancy-related hypertensive disorder generally occurring after 20 weeks of gestational age. The condition has multisystemic effects, of which the eye is one. Common ocular symptoms in pre-eclamptic women include scotomas, blurred vision, diplopia, chromatopsia, hemianopsia, present in about 25% of PE women. Ocular ultrasound is a readily available cheap imaging modality that can demonstrate and diagnose some of the ocular pathologies in pre-eclamptic women. Unfortunately, almost all pre-eclamptic women attending the antenatal clinics (ANC) in Kawempe national referral hospital and various ANCs in Uganda never have an ocular examination even if they have symptoms. This has created an information gap where we do not know the incidence of ocular pathologies and the prevalence of associated morbidity in the community. The objective of the study was to determine the patterns, prevalence, and factors associated with ocular sonographic manifestations among pre-eclamptic women at Kawempe national referral hospital. This was a cross-sectional study carried out at Kawempe national referral hospital. The study population was 387 pre-eclamptic women. An ocular B mode and ophthalmic artery doppler ultrasound was done for each pre-eclamptic woman, and a questionnaire was used to collect clinical data and record sonographic findings. Three hundred and eighty-seven pre-eclamptic women were included in the study. The prevalence of ocular manifestations among pre-eclamptic women was 14.2% (55 out of the 387). The prevalence of retinal detachment was 1%. The median optic nerve sheath diameter was 4.99 mm. The mean optic disc height was 0.86 and above average for normal pregnant women. At bivariate analysis, maternal age above 30 was associated with ocular sonographic findings (p< 0.004 ). Gestational age, parity, symptoms, prevalues were not significant. One in ten women with pre eclampsia severity, and medication eclampsia in our population is likely to have ocular sonographic manifestations. Women above 30 years of age with preeclampsia are at a higher risk of ocular disease in preeclampsia. Ocular ultrasound is a viable tool to investigate/ screen for ocular disease in preeclampsia. Older pre-eclamptic women above 30 years with acute visual symptoms should have an ocular ultrasound scan done to assess for ocular disease related to preeclampsia at Kawempe National Referral Hospital. The mothers with severe ocular disease need to be referred and followed up by an ophthalmologist after delivery for further management.