Permanent Severe Visual Field Defect Following Pre-eclampsia and Multiple Ophthalmological Pathologies: A Case Report

TL;DR

A 43-year-old woman developed severe vision loss after pre-eclampsia, with multiple possible causes remaining unclear.

Contribution

This case highlights the complex interaction of multiple ophthalmological and systemic pathologies leading to severe visual field loss.

Findings

The patient had a severe concentric visual field defect, reduced visual acuity, and impaired color vision.

OCT showed bilateral serous macular detachment related to pre-eclampsia.

A brain MRI revealed a microstroke, but it did not fully explain the severity of the visual field loss.

Abstract

This clinical report discusses the interplay of various pathologies that may present similar clinical manifestations, with uncertainty about the distinct impact of each one of them.

The patient is a 43-year-old young Asian female with no known medical conditions. She was 33 weeks pregnant when she was admitted for an urgent c-section because of preeclampsia with HELLP syndrome. While hospitalized, she complained about the visual field’s loss. A comprehensive ophthalmological examination revealed a severe concentric visual field defect along with well-reduced visual acuity and impaired color vision. Her OCT revealed a bilateral serous macular detachment related to pre-eclampsia. A brain MRI revealed a microstroke at the temporo-parieto-occipital junction (TPO), although it did not fully account for the severity of the visual field deficit. Despite the macular pathology being resolved, the visual field remained deeply impacted. A thorough and complete investigation yielded negative results, leaving the cause of the patient’s deficit unknown. The patient likely had a normal pressure glaucoma. Additionally, multifactorial bilateral microvascular ischemic neuropathy (caused especially by high myopia) has significantly affected her visual field. Furthermore, it is also probable that the patient had genetic neuropathy. Initial genetic testing was negative; however, due to the high suspicion of a genetic component, a retest was conducted, and the results were not conclusive.

This case represents a highly unusual case of a profoundly affected visual field with no apparent identified cause. This is a notable example of the potential interaction of various local and systemic pathologies that can manifest with similar clinical presentations.

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