This 31YO postpartum female presented with sudden vision loss 3 days following delivery, which was complicated by severe preeclampsia (blood pressure was up to systolic 215 mmHg). Vision was 20/50 bilaterally.
Optos color RG imaging shows bilateral subretinal yellow bands and drusen-like changes. OCT shows disruption of the outer retinal bands with variable amorphous hyperreflective material and fluid. The RPE is variably thinned/absent as indicated by a visible Bruch’s membrane band. Fundus autofluorescence (FAF) shows extensive hyperreflective deposits in the temporal maculae.
Two weeks later, OCT shows resolved fluid with some restoration of the outer photoreceptor architecture.
Learning Points:
Posterior segment findings in toxemia of pregnancy, which develop in up to one-third of patients, are primarily due to choroidal ischemia with secondary RPE dysfunction and exudative retinal detachments. Outer retinal ischemia can cause bizarre and pathognomonic OCT changes as seen in our patient (Song et al, Graefes Arch Clin Exp Ophthalmol 2013;251:2647-2650).
The clinical and OCT findings recover remarkably within weeks following normalization of blood pressure. Upon resolution, the fundi can appear normal or reveal telltale subretinal pigment clumps (Elschnig spots), streaks (Siegrist streaks), or broad areas of RPE pigmentary changes with intraretinal migration that can mimic prior blunt trauma or rhegmatogenous retinal detachment.
