A 20-year old healthy primigravida complained of loss of vision 2 days post cesarean delivery due to severe preeclampsia. On presentation, her visual acuity was CF 1 m in the right eye and CF close to face left eye. Fundus examination in both the eyes showed retinal whitening with few retinal hemorrhages [Fig. 1a and b]. In the early phase of fluorescein angiography, there was hypofluorescence at the macula, which persisted into the late phase with blockage in macular retinal arterioles and capillaries suggestive of gross macular ischemia [Fig. 1c and d]. Optical coherence tomography in both the eyes showed hyperreflective nerve fiber layer with no associated macular edema [Fig. 1e and f]. Systemic workup revealed low hemoglobin (7.5 g/dL), decreased platelet counts (30,000/mm3), elevated erythrocyte sedimentation rate (65 mm/h), increased activated partial thromboplastin time (56 s), decreased prothrombin time (7 s), and elevated antiphospholipid IgG (35 IU/mL, normal <15 IU/mL) and IgM (33 IU/mL, normal <12 IU/mL) antibodies. A diagnosis of bilateral Purtscher-like retinopathy with gross macular ischemia in preeclampsia secondary to antiphospholipid syndrome was made. She was treated with tapering dose of oral corticostreroid (1 mg/kg to begin, and tapered every week) for 4 weeks. At 3-month follow-up, her visual acuity was 20/200 in the right eye and CF 2 m in the left eye; the optic discs were pale and there was foveal atrophy in both eyes [Fig. 1g and h]. Purtscher-like retinopathy, a rare finding in postpartum period following preeclampsia, can cause profound visual loss.[1] During pregnancy, there is an increased level of complement factors and clotting activity, which leads to arterial occlusive disorders.[2]
Figure 1.
(a and b) Color fundus photograph showing posterior pole retinal edema, cotton wool spots, and few retinal hemorrhages. (c and d) Fundus fluorescein angiography in the late phase showing blocked fluorescence secondary to macular ischemia. (e and f) Optical coherence tomography showing hyperreflective inner retinal layers with no macular edema. (g and h) Color fundus photograph at 3 months’ follow-up showing optic disc pallor, resolution of cotton wool spots, and foveal atrophy
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Agrawal A, McKibbin MA. Purtscher's and purtscher-like retinopathies: A review. Surv Ophthalmol. 2006;51:129–36. doi: 10.1016/j.survophthal.2005.12.003. [DOI] [PubMed] [Google Scholar]
- 2.Blodi BA, Johnson MW, Gass JD, Fine SL, Joffe LM. Purtscher's-like retinopathy after childbirth. Ophthalmology. 1990;97:1654–9. doi: 10.1016/s0161-6420(90)32365-5. [DOI] [PubMed] [Google Scholar]