A 33-year-old woman, 34 weeks pregnant (third pregnancy), with controlled pregnancy and no history of interest, was admitted to the emergency department with headaches, epigastric pain and blurred vision for 3 days.
The patient had a blood pressure (BP) of 210/130 mmHg.
Physical examination revealed edema (+++) in both lower limbs with fovea.
Laboratory data revealed elevated total aminotransferase and bilirubin transfer41, and a slight decrease in platelet count as measured by creatinine clearance 4.5A; hemoglobin12 g/dl; hematocrit 35 % (International level I).
Given the poor general condition of the patient it was not possible to determine the visual acuity.
Left endoscopy showed edema of both optic discs with serous retinal detachments, affecting both maculae, bullous in the right eye and somewhat flatter.
There were hemorrhages in the posterior pole of both eyes and focal narrowing of the iliac arteries.
The patient was admitted to the Intensive Care Unit where perfusion with Labetalol was initiated (5 mg per ml, 10 ml each hour) and intravenous ropivacaine (IV) was administered (1 mg every 6 hours).
TA decreased although it did not reach normal levels.
Cesarean section was performed urgently obtaining a male fetus of 1,800 grams.
After cesarean section the patient suffered oliguria of which she suffered later.
Normalization of transaminases, bilirubin, platelets and diuresis occurred, and control of AT with antihypertensive treatment was achieved.
The patient was seen again by our service after 5 days presenting: a visual acuity of 1.0 in the right eye and 1.0 difficult in the left eye.
Intraocular pressure was 14 mmHg in both eyes and anterior chamber biomicroscopy was normal.
At the bottom of the eye, the persistence of serous macular detachments, although flat, was observed.
In both eyes, edema of the optic disc and exudative peripapillary detachment persisted.
In the right eye there was a bullous detachment with level, located between the lower vascular arcades, in the nasal area and lower than the disc.
In the left eye, it was possible to distinguish a temporal fixation line to the macula delimiting the serous detachment, initially bullous.
In the early phases of fluorescein angiography, there was a delay in filling the choriocapilar, which was very evident at the peripapillary level.
The most advanced phases showed foci of progressive diffusion in the subpigmentary and subretinal space, with progressive filling of areas of serous detachment.
Thirty days after admission, the vessels had a normal appearance, had detachments, papilledema and bleeding.
Only the left eye line persisted.
In areas where detachments had previously been observed focal areas of hyper- and hypopigmentation.
Three months later the patient had recovered and her visual acuity was 1.0 in both eyes.
On examination of the eye fundus only the presence of focal abnormalities of hyper- and hypopigmentation where the retina had been neglected was remarkable.
