AASCIT Journal of Medicine

2016; 2(2): 19-22

http://www.aascit.org/journal/medicine

ISSN: 2381-1420 (Print); ISSN: 2381-1447 (Online)

Keywords Maternal Cataract,

Pregnancy,

Caesarean Section

Received: September 29, 2016

Accepted: October 11, 2016

Published: October 18, 2016

Postnatal Maternal Transient Visual Impairment with Cataract Formation

Ibrahim Kocak1, *

, Haci Koc2, Hakan Baybora

1, Faruk Kaya

1

1Department of Ophthalmology, School of Medicine, Medipol University, Istanbul, Turkey 2Retina Department, Inci Eye Hospital, Sakarya, Turkey

Email address ibrahimkocak@msn.com (I. Kocak) *Corresponding author

Citation Ibrahim Kocak, Haci Koc, Hakan Baybora, Faruk Kaya. Postnatal Maternal Transient Visual

Impairment with Cataract Formation. American Journal of Ophthalmology & Visual Science.

Vol. 2, No. 2, 2016, pp. 19-22.

Abstract Many maternal changes may occur in eye during pregnancy. A cataract formation after

delivery is presented in the current case. A 28 years old female was referred from the

obstetrics and gynecology clinic with bilateral blurring of vision after an uneventful

caesarean section. Her best correction visual acuity (BCVA) was 0.6 in the right eye, and

0.7 in the left. Anterior segment slit lamp examination revealed bilateral nuclear cataract.

Dilated fundus examination had no pathological sign. The presenting cataract formation in

the presenting case might imply to metabolic changes in lens or fluid retention in nucleus.

1. Introduction

Hormonal and metabolic changes in pregnancy may cause modifications or disorders

in visual system and eyes. Pregnancy can show a spectrum of ocular manifestations

including subtle subclinic physiologic changes, eye diseases occurring during the

pregnancy, and alterations of preexisting eye diseases. Modifications in cornea, lens,

intraocular pressure (IOP), retinal and choroidal circulation may occur during the

pregnancy. Pregnancy can either have a beneficial effect, as in uveitis, with a lower

incidence of exacerbations, or deterioration in case of a preexisting diabetic retinopathy

[1]. In the current case, an acute bilateral blurring of vision with bilateral cataract after

delivery is presented.

2. Case Report

A 28 years old female was referred from the obstetrics and gynecology clinic with

bilateral blurring of vision after an uneventful caesarean section. She had an uneventful

pregnancy period without preeclampsia, eclampsia, or gestational diabetes mellitus. Her

arterial tension was 130/80 mmHg whilst the blurring of vision. Systemic and neurologic

examination revealed no pathology. Biochemical and hematologic investigations were in

normal range. Cranial magnetic resonance images showed no pathological sign. Her best

correction visual acuity (BCVA) was 0.6 in the right eye, and 0.7 in left. IOP was 14 in

right and 15 in left eye. Anterior segment slit lamp examination revealed bilateral

nuclear cataract (Fig. 1a and 1b). Dilated fundus examination had no pathological sign.

Optical coherence tomography was performed to eliminate any possible subtle exudative

retinal pathology related to pregnancy. Yet, OCT showed normal macular morphology

AASCIT Journal of Medicine 2016; 2(2): 19-22 20

(Fig. 2). The patient had been sent for follow-up, but she left the

city a few days after delivery. She denoted the complete visual

recovery after the first week of delivery when she was connected

by phone, nevertheless we were not able to assess the status of

cataract formation owing to loss of follow up examinations.

Fig. 1a. Slit lamp view of nuclear cataract.

Fig. 1b. Retroillumination view of cataract.

Fig. 2. Macular OCT images of the left eye. Note the blurring effect of the cataract on the SLO image. Macular morphology shows no abnormal finding.

21 Ibrahim Kocak et al.: Postnatal Maternal Transient Visual Impairment with Cataract Formation

3. Discussion

Many maternal changes may occur in eye during

pregnancy. Skin changes like chloasma and spider angioma

are frequent during pregnancy. Ptosis has been reported

during and following normal pregnancies, with one patient

worsening after each of three pregnancies. [2-4].

Changes in conjunctival blood vessels have been described

toward the end of normal pregnancies. A study reported

constriction of conjunctival arterioles, granularity of the

conjunctival venules, and decreased visualization of

conjunctival capillaries [5]. Another study showed increased

vessel diameter in the second and third trimester of

pregnancy [6]. The conjunctival epithelium has been shown

to undergo cytological changes during pregnancy related to

elevated estrogen levels [7]

Some studies reported increased corneal thickness during

pregnancy with resolution a short time after delivery. Fluid

retention that is often associated with pregnancy may be a

factor inducing increased corneal thickness [8-10] The

corneal curvature has been found to steepen by one diopter

on average in the second and third trimesters, with resolution

after delivery or cessation of breastfeeding [11]

Some studies showed IOP reduction during pregnancy.

This ocular hypotensive effect increases until delivery and

persists for several months after delivery. This hypotensive

effect may be related to increased outflow facility and

particularly increased uveascleral outflow as a consequent of

hormonal changes [12-19].

Pre-eclampsia typically develops in the second half of

pregnancy and is characterized by hypertension, edema, and

proteinuria. Scotoma, diplopia, dimness of vision, and

photopsy were noted in 25% of patients with severe pre-

eclampsia and in up to 50% of patients with eclampsia.

Bilateral serous retinal detachment due to choroidal

dysfunction may occur in preeclampsia or eclampsia [20].

Graves’ disease is shown to improve during the second

and third trimester of the pregnancy. This may be related to a

change in the specificity of TSH receptor antibody from

stimulatory to blocking activity during pregnancy [21].

Diabetic retinopathy and idiopathic uveitis may deteriorate

during pregnancy or after delivery. [22, 23] Tight glucose

control is mandatory in preventing diabetic retinopathy

progression

The mechanism of cataract development is not exactly

clear. Oxygen-free radicals may be a major factor in the

development of cataracts. Infections, smoking, toxins,

ultraviolet radiation, and many other factors can promote

reactions that release excessive amounts of oxygen-free

radicals leading to cataract formation. Deficiency of anti-

oxidants, particularly glutathione, may be an additive factor

promoting cataract formation. Glutathione is found to be in

high levels in the eye and neutralizes free radicals. In the

aging eye, barriers develop that prevent glutathione from

reaching the nucleus in the lens, thus making it vulnerable to

oxidation. Pregnancy may induce lens changes. Crystalline

lens curvature increase has been reported in a study [24]. A

transient loss of accommodation may occur during and after

pregnancy [25]. A study reported that having more than three

babies doubled the risk of developing bilateral cataracts in

the 35- to 45-year age range [26]. An increase in lens

autofluorescence has been reported in pregnant patients with

diabetes compared with nonpregnant diabetic patients [27].

This observation suggests the possibility of lenticular

metabolic alterations during pregnancy.

4. Conclusion

In the current case these metabolic changes might induce

cataract formation or increase the preexisting congenital

cataract formation. Alterations in the fluid equilibrium of

body due to hormonal changes might lead to fluid retention

in the nucleus and give rise to cataract formation. To our

knowledge, there is no reported cataract formation after

caesarean section in the literature. The presenting cataract

formation in the current case might imply to metabolic

changes in lens or fluid retention in nucleus during

pregnancy.

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