PURPOSE: The purpose of the study was to compare the choroidal thickness (CT) in pre-eclamptic (PE), healthy pregnant, and age-matched healthy non-pregnant females by spectral-domain optical coherence tomography (SD-OCT) and to investigate any possible correlation between subfoveal CT (SFCT) and mean arterial pressure (MAP) in PE. METHODS: This was a hospital-based, comparative study. A total of 90 females (30 in each group) aged 20-40 years were recruited prospectively over 1 year. Females with refractive error beyond ±3 D, intraocular pressure >
21 mmHg, prior ocular trauma or surgeries, systemic diseases, pregnancy-related complications (except PE), and poor OCT scans were excluded. Following comprehensive ophthalmic evaluation, CT was measured bilaterally using SD-OCT (EDI) at the subfoveal region and at 1500 µm nasal and temporal to fovea. Systolic and diastolic blood pressures were recorded in all. RESULTS: The PE group had significantly thinner choroid (SFCT: 337.5 ± 49.8 OD, 333.0 ± 50.8 OS) as compared to the healthy non-pregnant group (SFCT: 351.6 ± 34.4 OD, 365.3 ± 33.6 OS) and healthy pregnant group (SFCT: 374.2 ± 44.1 OD, 377.2 ± 49.5 OS) ( P <
0.05) in all locations (nasal, temporal, and subfoveal) in both eyes (except for OD nasal CT). However, there was no significant correlation between SFCT and MAP in the PE group. CONCLUSION: Significantly lower CT in PE without any direct correlation between SFCT and MAP may implicate that choroidal thinning in PE is governed by multifactorial choroidal vasospasm and endothelial dysfunction, instead of MAP solely.