Maurice F. Rabb » Acute Macular Neuroretinopathy

A healthy 28 year old woman had an elective cesarean section performed under spinal anesthesia, and a healthy infant was delivered. Following delivery, there was uterine bleeding and 10 units of Pitocin was given by intravenous push into the intravenous tubing and flushing with solution that contained 25 mg of Ephedrine in one liter of lactated Ringer's.

The patient immediately complained of severe headache and blood pressure rose to 200/80. Multiple cardiac extrasystoles developed and these were controlled by 100 mg of lidocaine intravenously. Intravenous sodium pentothal was administered for general anesthesia and the operation was completed.

When the patient awakened, she noticed a visual disturbance that consisted of prominent paracentral scotomas in both eyes. She was seen by a neurologist on the following day who found visual acuity of 20/200 in each eye, not improved by pin hole. Fundus examination was said to show macular edema and a cherry red spot in the macula of each eye. Over the next few days the patient noticed improvement of central vision but persistence of paracentral scotomas.

I first saw the patient six weeks following the episode. Corrected visual acuity was 20/20 in each eye. Eye examination was normal except for macular lesions that appeared darker red than the surrounding retina. The lesions appeared to be located in the outer retina. Fluorescein angiography showed faint hypofluorescence corresponding to the lesions. Paracentral scotomas corresponding to the retinal lesions were found in both eyes by Goldmann perimetry and Amsler grid testing.

The patient has noticed very gradual clearing of the scotomas over the ensuing six weeks.