A 33 year old white woman presented with a history of a central scotoma in the right eye for the past ten days. She had enjoyed good health and was 4.5 months pregnant.
Vision was 20/400 in the right eye and 20/20 in the left eye. Slit lamp examination revealed no anterior chamber reaction and no cells in the vitreous.
The retinal examination of the right eye revealed a focal area of retinal pigment epithelial disturbance with loss of the foveal reflex. No serous retinal detachment was seen. Amsler grid testing revealed a central scotoma. The slit lamp and retinal examinations of the left eye were entirely normal. No angiogram was performed because of the pregnancy. Electroretinography and electro-oculography were normal.
Course: In August of 1987 patient had mild toxemia and was hospitalized for one week. In September of 1987 she had an uncomplicated delivery and her visual acuity was 20/200 OD and 20/15 OS. In March of 1989, the patient experienced subjective visual acuity of 20/200 with new temporal paramacular yellowish-gray retinal pigment epithelial changes on fluorescein angiography. A blocking defect was seen with late staining at the site of the new retinal pigment epithelial lesions. In September of 1990, the patient experienced a new paracentral scotoma in her right eye. Visual acuity was 20/60 in the right eye and there were new temporal paramacular grayish retinal pigment epithelial changes. Similar angiographic features were present to the angiogram performed in March of 1989. In February of 1991, the patient again noted a paracentral scotoma with new retinal pigment epithelial changes in the nasal paramacular area. In February of 1991, for the first time, there was a small focal area of retinal pigment epithelial disturbance nasal to the left disk. The left eye remained asymptomatic and visual acuity was 20/15.
On May 10, 1993, the patient presented with a paracentral scotoma in the left eye. Visual acuity was 20/60 in the right eye and 20/20 in the left eye. There was a focal yellowish lesion in the temporal paramacular area with no overlying serous retinal detachment and no vitreous cells. By May 24, 1993, the retinal pigment epithelial changes had become more diffuse and had extended into the macula and the visual acuity in the left eye was 20/200.
A project from the American Society of Retina Specialists
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