Ophthalmic Artery Doppler Indices and Maternal Factors in the Prediction of Preeclampsia in a High-Risk Obstetric Population: A Prospective Cohort Study.

AIM: To evaluate the utility of ophthalmic artery Doppler (OAD) indices, combined with maternal clinical factors, mean arterial pressure (MAP), and uterine artery pulsatility index (UtA-PI), for the prediction of preeclampsia (PE) in a high-risk obstetric population at 18-24 weeks of gestation. METHODS: Prospective cohort study conducted at a tertiary referral unit (UMAE HGO-CMNO, IMSS, Guadalajara, Mexico) from January to December 2025. Singleton pregnancies with at least one major or two minor PE risk factors per NICE/ACOG guidelines were included. Assessments comprised MAP (bilateral brachial), UtA-PI (transabdominal Doppler), and OAD quantified as the second-to-first peak systolic velocity ratio (R-PSV1-2) via convex transducer over the right eye; R-PSV1-2 > 0.60 was defined as abnormal. Hierarchical logistic regression models and ROC analysis were constructed; significance was set at p < 0.05. RESULTS: Of 182 women included, 81 had abnormal OAD and 101 had normal OAD. Overall, PE occurred in 24 (13.2%): 20/81 (24.7%) in the abnormal group versus 4/101 (4.0%) in the normal group (OR 7.95, 95% CI 2.59-24.38; p < 0.001). All 16 early-onset PE cases (< 34 weeks) arose exclusively in the abnormal OAD group (sensitivity 100%, NPV 100%). The full model (clinical + MAP + UtA-PI + OAD) achieved an AUC of 0.815 (95% CI 0.698-0.909), superior to the clinical-only model (AUC 0.722). In multivariable analysis, abnormal OAD was the strongest independent predictor (adjusted OR, 6.49; 95% CI 1.91-22.03; p = 0.003). CONCLUSIONS: OAD at 18-24 weeks significantly improves PE prediction in high-risk pregnancies beyond conventional risk factors. Its perfect sensitivity and NPV for early-onset PE support its integration into multiparametric second-trimester screening protocols.