Bilateral Exudative Macula Detachment in a Mother with Pre-Eclampsia: Case Report and Review of Literature

Generalised exudative retinal detachment, choroidal infarction and cortical blindness are known visual threatening conditions in patients with pre-eclampsia/eclampsia. Localised macula detachment is an uncommon ocular feature in this emergency obstetric situation. A 33-year-old woman presented with features of severe pre-eclampsia at 26 weeks of gestation. She underwent an emergency lower segment cesarian section at 27 weeks with blood pressure of 180/100 during the crisis. She complained of visual loss three days after delivery. Ocular examination revealed visual acuity of 5/60 OD and 6/60 OS, and exudative detachment of macula in both eyes. The ocular findings resolved completely at three weeks post crisis, while blood pressure gradually reached normotensive level at six weeks after delivery. Acute severe rise of blood pressure in pregnant women with pre-eclampsia/eclampsia causes terminal arterial vasopasm. It leads to breakdown of blood retinal barrier and exudation of fluid into sub-retinal space. Aim of management is prioritized at stabilizing blood pressure without morbidity or mortality to both mother and fetus. We provide a literature review of similar cases from 2011 to 2017 with emphasize on blood pressure level during the crisis, sites of detachment and final visual acuity. Aggressive management of pre-eclampsia/eclampsia patients is essential. Majority had satisfactory final visual outcome. Level of blood pressure may not be related to sites of retinal detachment. A large prospective cohort is needed to evaluate this association objectively.