Irreversible vision loss in antiphospholipid syndrome complicated by pre-eclampsia: a case presentation and...

Area of Science:

• Obstetrics and Gynecology
• Ophthalmology
• Rheumatology

Background:

• Pre-eclampsia can cause reversible visual disturbances.
• Antiphospholipid syndrome (APS) is a known risk factor for obstetric complications.
• Severe pre-eclampsia in APS patients can lead to catastrophic outcomes.

Purpose of the Study:

• To present a case of irreversible visual loss in a patient with severe pre-eclampsia and APS.
• To highlight the limitations of standard prophylactic treatment in preventing severe maternal morbidity.
• To underscore the importance of close monitoring and timely intervention in high-risk pregnancies.

Main Methods:

• Case report of an 18-year-old woman with APS, gravida 2, abortion 1.
• Diagnosis of severe pre-eclampsia at 34 weeks gestation with highly triple positive antiphospholipid antibodies.
• Management included aspirin, enoxaparin, cesarean section, and subsequent ophthalmologic interventions.

Main Results:

• The patient developed bilateral visual loss secondary to serous retinal detachment and acute angle-closure glaucoma.
• Despite treatment, vision did not recover, resulting in legal blindness at five-year follow-up.
• This outcome occurred despite prophylactic aspirin and low molecular weight heparin (LMWH) therapy.

Conclusions:

• Pregnant women with APS require meticulous monitoring for pre-eclampsia, even with standard anticoagulant prophylaxis.
• Early and aggressive intervention is crucial to prevent severe visual impairment and other catastrophic outcomes.
• This case emphasizes the need for tailored management strategies in high-risk pregnancies.