Purtscher-like retinopathy with serous macular detachment in pre-eclampsia.

Purtscher-like retinopathy has been rarely described during postpartum period in patients with pre-eclampsia. We present an unusual combination of serous macular detachment coexisting with Purtscher-like retinopathy as a complication of pre-eclampsia during postpartum period.

INTRODUCTION

Purtscher-like retinopathy has been rarely reported to have an association with pre-eclampsia. It is characterized by cotton-wool patches, retinal whitening and superficial retinal hemorrhages. Serous macular detachment (SMD) has a common association of pre-eclampsia and it does not occur in Purtscher-like retinopathy.

CASE REPORT

A 21-year-old woman presented to our clinic with blurred visual acuity in both eyes occurring 3 days after delivery. Her visual acuity was hand motions in both eyes. Anterior segment findings and intraocular pressures were unremarkable in both eyes. Fundus examination showed multiple discrete yellowish cotton-wool spots at the posterior pole in both eyes. A fluorescein angiogram was not performed. She had a history of pre-eclampsia and un-complicated delivery. All laboratory investigations, systemic evaluations and blood pressure were normal at presentation. Optic coherence tomography (OCT) showed SMD, intraretinal fluid and hyperreflectivity in the inner retinal layers, explaining cotton-wool exudation in both eyes. Fundus autofluorence displayed decreased reflectance coming from the same area (Fig. 1).

Figure 1:

color fundus images: multiple discrete yellowish cotton-wool spots in the peripapillary retina in both eyes. Optic coherence tomography: serous retinal detachment, intraretinal fluid and hyperreflectivity in the inner retinal layers in both eyes. Fundus autofluorence: hyporeflective areas coming from cotton-wool spots in the peripapillary retina in both eyes

Discussion

Purtscher-like retinopathy is usually associated with severe head injury, blunt thoracic trauma, acute pancreatitis, renal failure and connective tissue disorders with vasculitis [1]. It has been rarely reported to have an association with pre-eclampsia [2, 3]. It is characterized by cotton-wool patches, retinal whitening, and superficial retinal hemorrhages. The pathological mechanism for Purtscher-like retinopathy remains unknown, but there have been many theories about precapillary occlusion; including fat emboli and/or leukoaggregation [1]. SMD has a common association of pre-eclampsia SMD and it does not occur in Purtscher-like retinopathy. OCT demonstrates that ischemia affects the inner retinal layers in Purtscher-like retinopathy and it enables the imaging of SMD. Visual recovery can occur spontaneously in the majoriy of patients. In literature, there have been case reports regarding the use of corticosteroid. There is no definitive guideline for the treatment of these cases [4].

This case highlights an unusual combination of SMD coexisting with Purtscher-like retinopathy as a complication of pre-eclampsia during postpartum period.