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Research Letter
April 2013

Nonarteritic Anterior Ischemic Optic Neuropathy in a 35-Year-Old Postpartum Woman With Recent Preeclampsia

Author Affiliations

Author Affiliations: Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock.

JAMA Ophthalmol. 2013;131(4):542-544. doi:10.1001/jamaophthalmol.2013.2884

Vision loss due to optic neuropathy in the immediate postpartum period can have a variety of causes, including blood loss1 and anesthetic complications.2 We describe a 35-year-old woman with resolving preeclampsia who had sudden unilateral vision loss after giving birth and had a clinical presentation consistent with nonarteritic anterior ischemic optic neuropathy (NAION).

A 35-year-old postpartum woman had sudden loss of vision in her right eye, noted approximately 8 days after vaginal delivery of her full-term baby. The patient had a history of preeclampsia (hypertension, protein in urine 452 mg/24 hours, and leg swelling) diagnosed 2 weeks before delivery. She had continued problems with blood pressure control since delivery, and she also reported severe headache prior to vision loss. There was no history of hypertension, smoking, or medication use. There was no significant ocular history. There was a history of gestational diabetes mellitus for the last 2 months of pregnancy. On initial examination, her blood pressure was 130/82 mm Hg and her weight was 95 kg. Her visual acuity was 20/200 OD and 20/15 OS. There was a relative afferent pupillary defect in the right eye. Ophthalmoscopy revealed superior segmental disc edema with some early pallor in the right eye and a normal disc (with a small cup-disc ratio) in the left eye (Figure 1). Results of the remainder of her ocular examination were normal. Findings on computed tomography and magnetic resonance imaging of the brain and orbits were normal. Results of the laboratory workup including complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein level were normal and she was negative for antinuclear antibodies. Humphrey automated visual field testing (30-2 Sita Fast) demonstrated an inferior altitudinal defect in the right eye and a normal field in the left eye (Figure 1). The working diagnosis was NAION. On follow-up approximately 6 weeks after her initial visit, visual acuity was 20/30 OD and 20/20 OS. Findings of the remainder of the examination were stable except for the development of some segmental superior disc pallor in the right eye (Figure 2). Results of repeated automated visual field testing were also unchanged (Figure 2).

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