Optometry case study: Central serous retinopathy secondary to pre-eclampsia

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Figure 2. Close up of LE OCT scan showing large area of sub-retinal fluid resulting in an elevation of the retina at the macula

By Chris Mouser, Specsavers Shepparton, VIC

History

Px: 23-year-old female
Reason for visit: Presented with an urgent referral from GP to assess her 2-day sudden onset vision loss. Patient was 35 weeks pregnant with her first child, and had no prior complications in the pregnancy. She reported waking the previous day with a loss of vision in her left eye and with a noticeable change in colour appearance. This had not resolved the following day, and the patient arranged an appointment with her GP, who advised optometry assessment. When asked, patient denied any tingling in arms or legs, or muscle weakness.

Clinical Assessment

VA: RE: 6/6         LE: 6/30
Red cap desaturation test: RE: 10/10      LE: 4/10
Fundus examination: Unremarkable in RE, central oedema in LE
Retinal vasculature: Normal
OCT: Showed large area of sub-retinal fluid in LE (Figures 1 and 2)

Figure 1. Comparison of RE (normal) and LE OCT scans
Figure 2. Close up of LE OCT scan showing large area of sub-retinal fluid resulting in an elevation of the retina at the macula

Diagnosis

Differential diagnoses:

  • Diabetic macular oedema
  • Idiopathic choroidal neovascular membrane (CNVM)

 Provisional diagnosis:

  • Central serous retinopathy

Ophthalmological assessment was not available for 5 days without a 2-hour trip, and a phone conversation with a retinal specialist advised to rule out pre-eclampsia. The ophthalmologist also mentioned that should it be an idiopathic CNVM requiring an intravitreal anti-VEGF injection, this would carry little risk to the foetus.

The patient’s GP was called and he advised that the patient’s blood pressure was borderline elevated, 145/92, and he arranged further tests for pre-eclampsia.

Outcome

The patient was admitted to hospital following tests confirming pre-eclampsia and had a healthy baby following an emergency caesarean section.

The prognosis for the patient was for good vision recovery.

Discussion

Pre-eclampsia is a complication that affects 2-8% of pregnancies causing elevated blood pressure, oedema and elevated protein in the urine. Visual symptoms can occur in 25-50% of cases.

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