Bilateral permanent concentric visual field defect secondary to severe pre-eclampsia

Abstract

Purpose To present a patient with bilateral permanent concentric visual field defect secondary to severe pre-eclampsia. Case report A forty-year-old woman presented to the ophthalmology department with partial visual field defect affecting her both eyes. She gave a history of emergent uterine curettage for severe uncontrolled pre-eclampsia in the 24th week of her second gestation which was 10 years before. Two days after the procedure, the patient complained of peripheral visual field defect in her both eyes which persisted until her last presentation. Her best-corrected visual acuity, color vision, intraocular pressures, and anterior segment examination findings were normal bilaterally. Fundus examination showed a normal optic nerve head with reduction of arteriole to vein ratio in both eyes. Humphrey Field Analyzer revealed a bilateral concentric visual field defect. Visual Evoked Potentials (VEP) and Electroretinography (ERG) were within normal limits in both eyes. Cranial magnetic resonance imaging (MRI) was normal. Discussion Herein, we presented a case of permanent concentric visual field defect which developed as a complication of severe uncontrolled pre-eclampsia. To the best of our knowledge; such a case has not been reported to date. Keywords: pregnancy, pre-eclampsia, concentric visual field defect Go to: Introduction Pre-eclampsia is characterized by the presence of hypertension, edema, and proteinuria and usually ensues after the second half of gestation (Sheth and Mieler 2001). Pre-eclampsia may progress to eclampsia which is characterized by seizures (Sheth and Mieler 2001). Approximately 5% of obstetric patients develop toxemia of pregnancy (Sheth and Mieler 2001; Pritchard et al 1985). In some patients, pregnancy-induced hypertension occurs in the setting of underlying hypertension. Although a small proportion of patients continue to suffer from chronic hypertension, pregnancy-induced hypertension usually resolves 1 to 5 months after delivery (Sunness 1988). In the course of a normal pregnancy, significant retinal vascular changes do not occur (Pritchard et al 1985; Sheth and Mieler 2001). However, retinal vascular changes in toxemia of pregnancy are commonly identified (Sunness 1988). Hypertension causes diminution of retinal arterioles in their diameter (Albert and Dryja 1989). In acute severe hypertension, as seen in toxemia of pregnancy, clinical changes initially appear as focal spasms. Chronic hypertension usually causes arteriolar sclerotic changes which results in slowly progressive and diffuse arteriolar luminal narrowing (Sheth and Mieler 2001). Wide speculation exists about the degree and pathogenetic mechanisms of visual field changes that may occur in pregnant women. Visual field loss patterns in pregnant women include bitemporal loss, concentric constriction, and enlarged blind spots (Albert and Dryja 1989). Proposed mechanisms are equally diverse and include changes in the pituitary gland that may affect the optic chiasm (Erdheim and Stumme 1969). Also, visual field defects may occur due to serous retinal detachment, retinal hemorrhage, optic nerve head edema, and involve the central nervous system. These visual field changes were shown to be reversible at ten days postpartum (Sunness 1988). We describe a patient with bilateral permanent concentric visual field defect secondary to severe pre-eclampsia. Go to: Case report A forty-year-old woman suffering from bilateral persistent visual field defect with duration of 10 years admitted to our clinic. Her best-corrected visual acuity was 20/20 OD and 20/20 OS. Color vision and anterior segment examination findings were bilaterally normal. Intraocular pressures with applanation were 15 mmHg OD and 14 mmHg OS respectively. The fundus examination disclosed a normal optic nerve head with reduction of arteriole to vein ratio in both eyes. None of the family members were known to have similar ocular or systemic findings. Her blood pressure was 130/80 mmHg. Clinical and laboratory investigations were within normal limits indicating no systemic disorder. Her automated visual field examination with Humphrey Field Analyzer revealed a bilateral concentric visual field defect (Figure 1). A repeated Humphrey Field Analysis which performed 4 weeks later was confirmatory. The same concentric visual field defect was present in her visual field examination which was performed 10 years before.