Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 2822
  • Home
  • Print this page
  • Email this page

   Table of Contents      
OPHTHALMIC IMAGE
Year : 2019  |  Volume : 67  |  Issue : 11  |  Page : 1883

Bilateral Purtscher-like retinopathy with macular ischemia in preeclampsia secondary to antiphospholipid syndrome


Retina and Vitreous Services, L V Prasad Eye Institute, Vijayawada, Andra Pradesh, India

Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. Vishal Raval
Retina and Vitreous Services, L V Prasad Eye Institute, Vijayawada - 521 137, Andra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_792_19

Rights and Permissions

How to cite this article:
Raval V, Das T. Bilateral Purtscher-like retinopathy with macular ischemia in preeclampsia secondary to antiphospholipid syndrome. Indian J Ophthalmol 2019;67:1883

How to cite this URL:
Raval V, Das T. Bilateral Purtscher-like retinopathy with macular ischemia in preeclampsia secondary to antiphospholipid syndrome. Indian J Ophthalmol [serial online] 2019 [cited 2019 Nov 18];67:1883. Available from: http://www.ijo.in/text.asp?2019/67/11/1883/269640



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 [Figure 1]a and [Figure 1]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 [Figure 1]c and [Figure 1]d. Optical coherence tomography in both the eyes showed hyperreflective nerve fiber layer with no associated macular edema [Figure 1]e and [Figure 1]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 [Figure 1]g and [Figure 1]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

Click here to view


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 Top

1.
Agrawal A, McKibbin MA. Purtscher's and purtscher-like retinopathies: A review. Surv Ophthalmol 2006;51:129-36.  Back to cited text no. 1
    
2.
Blodi BA, Johnson MW, Gass JD, Fine SL, Joffe LM. Purtscher's-like retinopathy after childbirth. Ophthalmology 1990;97:1654-9.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed148    
    Printed1    
    Emailed0    
    PDF Downloaded64    
    Comments [Add]    

Recommend this journal