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JAMA Ophthalmology Clinical Challenge
July 2017

Bilateral Decreased Vision During Pregnancy

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2017;135(7):807-808. doi:10.1001/jamaophthalmol.2016.5453

A pregnant woman in her 30s presented at 20 weeks with a 4-week history of bilateral decreased vision. Her medical history was remarkable for type 2 diabetes (which was well-controlled with insulin), and a review of systems found that she had not experienced headache, pain, or neurologic complaints. Her blood pressure was 102/54, and her best-corrected visual acuity was 20/50 OD and 20/40 OS without afferent pupillary defect, motility disturbance, or intraocular pressure abnormalities. A fundus examination was remarkable for bilateral hyperemic discs and macular edema and subretinal fluid, with numerous flame-shaped hemorrhages in 4 quadrants without microaneurysms, exudates, or neovascularization (Figure). There was no evidence of intraocular inflammation. Fluorescein angiography was deferred because of her pregnancy.

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