Indian Journal of Ophthalmology

OPHTHALMIC IMAGE
Year
: 2019  |  Volume : 67  |  Issue : 11  |  Page : 1883-

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


Vishal Raval, Taraprasad Das 
 Retina and Vitreous Services, L V Prasad Eye Institute, Vijayawada, Andra Pradesh, India

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




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;67:1883-1883


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 2020 Mar 29 ];67:1883-1883
Available from: http://www.ijo.in/text.asp?2019/67/11/1883/269640


Full Text



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}

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

1Agrawal A, McKibbin MA. Purtscher's and purtscher-like retinopathies: A review. Surv Ophthalmol 2006;51:129-36.
2Blodi BA, Johnson MW, Gass JD, Fine SL, Joffe LM. Purtscher's-like retinopathy after childbirth. Ophthalmology 1990;97:1654-9.