Atlas of Ophthalmology

Macular Capillary Occlusion and Paracentral Scotoma One Year after HELLP-Syndrome (Mosaic, Triton OCT, Visual Field)

Macular Capillary Occlusion and Paracentral Scotoma One Year after HELLP-Syndrome (Mosaic, Triton OCT, Visual Field)
Mosaic of Triton OCT-angiography, Visual Field, OS: focal area of macular capillary occlusion of deep retinal vasculature corresponding to paracentral scotoma. Patient: 34 years of age, female, BCVA 1.0 at OD, 1.0 at OS, IOP 12/14 mmHg. ___Ocular Medical History: during pregnancy decrease of vision in OD and OS, after delivering of baby normalization of visual acuity, visual field defects remained. ___General Medical History: during pregnancy extensive high blood pressure values with diagnosis of HELLP syndrome. ___Main Complaint: persistent visual field defects in OD and OS. ___Purpose: to present focal macular microcirculatory defects with corresponding visual field defects one year after HELLP syndrome. ___Methods: Colour Photography Posterior Pole, Triton OCT-angiography, visual field. ___Findings: Colour Photography Posterior Pole, OD: dilated capillaries, pale optic nerve head, segmental optic nerve atrophy. Colour Photography Posterior Pole, OS: pale optic nerve head, segmental optic nerve atrophy. Visual Field, OD: small paracentral scotomas. Visual Field, OS: small paracentral scotomas. Triton OCT, OD: small focal V-shaped irregularities, probably residuals of the Elschnig's spots. Triton OCT-angiography, retina, OD: focal areas of macular capillary occlusion Triton OCT-angiography, retina OS: focal areas of macular capillary occlusion Triton OCT-angiography, choriocapillaries, OD: no sign of choroidal ischemia, no choroidal vascular abnormalities. Triton OCT-angiography, , choriocapillaries, OS: no sign of choroidal ischemia, no choroidal vascular abnormalities. Triton OCT, retinal nerve layer, OD: temporally thinned retinal nerve layer. Triton OCT- retinal nerve layer, OS: temporally thinned retinal nerve layer. Triton OCT- retinal ganglien cell layer, OD: strongly thinned retinal ganglion cell layer. Triton OCT- retinal ganglien cell layer, OS: strongly thinned retinal ganglion cell layer Mosaic Triton OCT-angiography, Visual Field, OS: focal area of macular capillary occlusion in deep retinal vasculature corresponding to paracentral scotoma. ___Discussion: Preeclampsia is a multisystem disorder defined as new onset of arterial hypertension and proteinuria during the second half of pregnancy. Serous retinal detachment is a known complication of preeclampsia caused by choroidal ischemia and subsequent disruption of blood-retinal barrier. Poor perfusion of the choriocapillaris causes Elschnig's spots. Central serous chorioretinopathy, central cilioretinal artery or vein occlusion and optic nerve atrophy are pathological manifestations in complicated pregnancies, when arterial hypertension is present (PIH), in preeclampsia (PE) or eclampsia. HELLP syndrome means disseminated intravascular coagulation, and idiopathic thrombocytopenic purpura may lead to ocular manifestations with loss of visual field or acuity. 1-2 ___Literature: 1. AlTalbishi A1, Khateb S, Amer R. Elschnig's spots in the acute and remission stages in preeclampsia: spectral-domain optical coherence tomographic features. Eur J Ophthalmol. 2015 Jul 30;25(5):e84-7. 2. Velazquez-Villoria D1, Marti Rodrigo P, DeNicola ML, Zapata Vitori MA, Segura García A, García-Arumí J. SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY EVALUATION OF CHORIORETINAL CHANGES IN HYPERTENSIVE CHOROIDOPATHY RELATED TO HELLP SYNDROME. Retin Cases Brief Rep. 2017 Jan 6.
Michelson, Georg, Prof. Dr. med., Interdisciplinary Center of Preventive Ophthalmology and Imaging, Dept. Ophthalmology, Friedrich-Alexander University, Erlangen, Erlangen, Germany
H47.293
Retina -> Vascular Diseases / Systemic Immunologic Diseases/ Diabetes mellitus -> Arterial Obstructive Disease of the Eye -> Bitemporal Optic Nerve Atrophy and Focal Macular Capillary Occlusions One Year after HELLP-Syndrome (Colour Photography Posterior Pole, Triton OCT-angiography, Visual Field)
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