A 33-year-old woman, 34 weeks pregnant (third pregnancy) with a controlled pregnancy and no history of interest, was admitted to the emergency department for headaches, epigastric pain and blurred vision of 3 days' duration. The patient's blood pressure (BP) was 210/130 mmHg. Physical examination revealed oedema (+ + + + +) in both lower limbs, with fovea. Laboratory data showed elevated transaminases and bilirubin, and a slight decrease in platelets: red blood cells 4.52; haemoglobin 12 g/dl; haematocrit 4.52; haemoglobin 12 g/dl; haemoglobin 12 g/dl. /dl; haematocrit 35% (these data in a pregnant woman suggest haemoconcentration); platelets 150; coagulation study: normal; creatinine 1.48 mg/dl; aspartate amino transferase (A.S.T.): 885.2 international units (I.U.); alanine amino transferase (A.L.T.): 334 I.U.; total bilirubin: 4.41 mg/dl; proteinuria was 500 mg/dl.
Given the patient's poor general condition it was not possible to determine visual acuity. Ophthalmoscopy showed oedema of both optic discs with serous retinal detachment, affecting both maculae, bullous in the right eye and somewhat flatter in the left eye. There were haemorrhages in the posterior pole of both eyes and focal narrowing of the retinal arteries.
The patient was admitted to the Intensive Care Unit where perfusion with Labetalol (5 mg per ml, 10 ml every hour) was started and intravenous (IV) Enalapril (1 mg every 6 hours) was prescribed. The BP decreased but did not reach normal levels. In view of this situation, an emergency caesarean section was performed and a male foetus weighing 1,800 grams was obtained. After the caesarean section the patient suffered oliguria from which she subsequently recovered. Transaminases, bilirubin, platelets and diuresis normalised, and control of BP was achieved with antihypertensive treatment.
The patient was seen again by our department 5 days later, presenting: visual acuity of 1.0 in the right eye and 1.0 difficult in the left eye. Intraocular pressure was 14 mmHg in both eyes and anterior chamber biomicroscopy was normal. Fundus examination showed persistent but flat macular serous detachments. Optic disc oedema and peripapillary exudative detachment persisted in both eyes. In the right eye there was a bullous detachment with level, located between the inferior vascular arcades, in the nasal area and inferior to the disc. In the left eye it was possible to distinguish a temporal demarcation line to the macula delimiting the serous detachment, initially bullous. In the early stages of fluorescein angiography, a delay in the filling of the choriocapillaris was observed, very evident at the peripapillary level. The later stages showed progressive diffusion foci in the subpigmentary and subretinal space, with progressive filling of the areas of serous detachment.
Thirty days after admission, the vessels had a normal appearance, the detachments had disappeared, as well as the papillary oedema and haemorrhages. Only the demarcation line persisted in the left eye. Focal areas of hyper- and hypopigmentation were observed in the areas where the detachments had previously been present.
After three months the patient had recovered, with a visual acuity of 1.0 in both eyes. In the fundus examination only the presence of focal hyper- and hypopigmentation where the retina had been detached was remarkable.