This patient was toxemic before delivery, with rapid bilateral vision loss and severely elevated blood pressure. When we examined her 10 days postpartum, her vision was counting fingers bilaterally.
There are multiple patches of creamy white, ischemic RPE and outer retina scattered throughout both posterior poles.
OCT scanning shows normal inner retinal bands extending from the internal limiting membrane to the inner nuclear layer, but the photoreceptor layers showed multiple additional hypo- and hyper-reflective bands, outer retinal disorganization, retinal edema, thickened RPE, and RPE loss with visible Bruch’s membrane.
One month later, vision remarkably improved to 20/25 bilaterally. The creamy multifocal lesions resolved, with residual pigmentary changes.
The prior OCT outer retinal changes resolved, with residual outer retinal and RPE atrophy.
Learning Points:
Toxemia causes choroidal ischemia with secondary RPE dysfunction, which can cause exudative retinal detachments.
Acute outer retinal ischemia causes these transient, bizarre, and pathognomonic OCT changes.
