A Rare Event Causing Blindness in an Unrecognised Pregnancy: A Case Report

Purtscher-like retinopathy (PLR) is a rare, non-traumatic microembolic angiopathy characteristically associated with systemic endothelial conditions, including pre-eclampsia. While PLR typically exhibits a self-limiting course with a highly favourable visual prognosis, severe cases result in permanent, treatment-refractory blindness. We present a catastrophic, atypical case of bilateral PLR in an unrecognised pregnancy without any antenatal care. A 31-year-old primigravida without prior antenatal screening presented with a three-day history of sudden, bilateral central blurry vision and was newly diagnosed with severe pre-eclampsia. On presentation, her best-corrected visual acuity was 2/60 in the right eye and 3/60 in the left eye. Fundoscopy revealed prominent bilateral optic disc swelling, a complete macular star, and generalised Purtscher flecken. Optical coherence tomography confirmed severe macular oedema accompanied by serous macular detachment. Despite timely intervention with high-dose intravenous methylprednisolone, followed by a three-week tapering course of oral prednisolone, her visual acuity remained poor at the two-month follow-up, after which the patient defaulted. This case demonstrates that the co-existence of PLR with serous macular detachment represents an unusually severe tier of blood-retinal barrier breakdown. Furthermore, it highlights that a total lack of prenatal monitoring allows gestational hypertensive vasospasm to cascade, precipitating irreversible macular ischaemia that is entirely refractory to aggressive rescue corticosteroid therapy.