Bilateral Purtscher-like retinopathy: A case report in a patient with pre-eclampsia and post intrauterine fetal demise

INTRODUCTIONPurtscher's retinopathy is a rare ophthalmic condition with unclear pathogenesis commonly related to trauma and affecting young or middle-aged men. The annual incidence in the UK has been estimated to be 0.24 cases per million.PRESENTATION OF CASEA 29-year-old primigravida female, previously healthy with no antenatal care, was brought to the maternal causality at 36 weeks of gestation as a case of pre-eclampsia and intrauterine fetal demise (IUFD) after a prolonged delivery attempt at home. After delivery, the patient reported bilateral vision loss. On ophthalmic examination, the best-corrected visual acuity (BCVA) was count fingers at 15 cm in both eyes. Dilated fundus exam showed scattered flame-shaped hemorrhage, multiple cotton wool Spots known as Purtscher flecken were seen in the distribution of the radial peripapillary capillary, dot and blot hemorrhage, and macular star in both eyes. The patient was treated with labetalol and magnesium sulphate for systemic control of arterial blood pressure by the obstetrics team, and managed conservatively under ophthalmic observation. Upon five months follow-up, BCVA had improved bilaterally.DISCUSSIONVisual changes have been reported in 25 % of patients with preeclampsia. Although most of these changes are transient, some rare sight-threatening eye conditions have been linked to preeclampsia namely Purtscher-like retinopathy.CONCLUSIONSPurtscher-like retinopathy is rarely reported in preeclampsia and after childbirth. Although most of visual changes associated with preeclampsia are transient, urgent ophthalmology consultation is important to rule out serious etiologies such as Purtscher-like retinopathy.