Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy: complications and management.

Abstract

We report the management of a young woman with preeclampsia of pregnancy who developed bilateral Purtscher-like retinopathy and serous retinal detachment subsequently complicated by macular hole and tractional retinal detachment. The best-corrected visual acuity was 20/1000 bilaterally. Fundus examination showed a picture of Purtscher-like retinopathy bilaterally and a macular hole in the right eye. Fluorescein angiography showed areas of capillary dropout and Elschnig spots bilaterally. Optical coherence tomography confirmed the macular hole in the right eye and a shallow serous retinal detachment bilaterally. Systemic and laboratory workup was unremarkable. Triamcinolone acetonide (4 mg/0.1 mL) was injected intravitreally in the left eye; vitrectomy was advised for the right eye. However, when the patient returned after 4 months, the right eye had developed a macular tractional retinal detachment. Vitrectomy, membrane peeling, and gas tamponade were performed. When the patient returned 4 months after the intravitreal injection in the left eye, best-corrected visual acuity had improved to 20/40 with complete resolution of serous retinal detachment in that eye. Best-corrected visual acuity in the right eye remained at 20/1000 but with anatomic deterioration. One month after vitrectomy for the macular hole and tractional retinal detachment in the right eye, best-corrected visual acuity improved to 20/240 with normalizing foveal contours. Status quo was observed in both eyes for the next 8 months. Final best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. An unusual combination of Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy and its complication-macular hole with tractional retinal detachment-were managed by surgery and pharmacotherapy.