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

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.

Keywords: glaucoma suspect; high myopia; optic nerve ischemia; pre-eclampsia; systemic lupus erythema; visual field defect.

Figure 1. Fundus photography

Note the tilted discs

Figure 2. The first patient’s visual field exam (30-2, SITA fast)

Figure 3. Macular optical coherence tomography

RE: right eye, LE: left eye

Figure 4. Brain MRI (T2)

Note the hypersignal in the temporo-parieto-occipital junction (TPO)

Figure 5. Abdominal CT scan

A: Abdominal hematoma, B: Inferior cave vein thrombosis, C: Left renal vein thrombosis

Figure 6. Visual field testing performed 10 days after the first exam

Figure 7. Visual field exams during the follow-up

Figure 8. IOP evolution and treatments

IOP: Intra ocular pressure, SLT: Selective laser traculoplasty, CCT: Central corneal thickness