Título / Title

SUDDEN VISUAL LOSS DUE TO COMBINED VASCULAR OCCLUSION IN A PREGNANT PATIENT

Introdução / Purpose

In this case report we discuss combined vascular retinal occlusion in a second trimester pregnant patient.

Material e Método / Methods

Not Apply

Resultados / Results

Female, 25 years old, 26 week pregnant, presented with sudden painless low visual acuity (VA) in the left eye (OS) seven days before attending the ophthalmologic ER. She did not have any history of diseases or surgeries. She had an abortion ten years ago during the first trimester of pregnancy due to Rh incompatibility and one pregnancy with no complications three years ago
At ophthalmological examination, VA was 20/20 in right eye (OD), luminous perception in OS and she showed paralytic mydriasis in OS. Fundoscopy in OS presented retinal hemorrhage in all four quadrants associated with a severe papilledema and a cherry red spot in macula topography with a slight whitening area around it leading to the hypothesis of combined central retinal artery and vein occlusion. Optical coherence tomography (OCT) revealed serous retinal detachment associated to a inner retina hyperreflectivity indicating an intracellular edema due to ischemia. Blood tests did not reveal any active infectious or rheumatological diseases. The coagulogram, doppler ultrasound of the carotid arteries and the skull computed tomography were within normality parameters

Discussão e Conclusões / Conclusion

Pregnancy is known to be associated with a hypercoagulable state. Ocular pathology may increase during pregnancy secondary to systemic diseases such as eclampsia, preeclampsia and Sheehan syndrome. Ischemic retinal vasculopathy can be caused by infectious processes, systemic inflammatory diseases, or vascular disorder. Although ocular changes are common in pregnancy, this patient has no risk factor other than gestation for retinal vascular occlusion. The aetiological investigation of this case represents a challenge because of the peculiarity of presenting signs of both arterial and venous occlusion.

Palavras Chave

VASCULAR OCCLUSION; PREGNANCY; ARTERIAL OCCLUSION; VENOUS OCCLUSION