First Author: R.Yela Delgado SPAIN
Co Author(s): M. Pascual Gonzalez P. Rojas Lozano J. Da Saude Lourenco M. Aparicio Hernandez-Lastras
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To present a case of unilateral papillophlebitis that developed during pregnancy in a primigravida. Our case provides valuable insights into the natural history and evolution of this entity during pregnancy as well as clinical management details.
The patient is followed up in our medical retina clinic at Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Extensive review of clinical and photographical documentation of the patient, as well as a comprehensive review of the available literature.
A 48 year-old primigravida (30-week-old gestation) presented complaining of blurred vision and veil sensation in the superotemporal region of her left eye (OS) for 3 days. She was on acetylsalicylic-acid 100 mg/day, prescribed by her obstetrician due to an altered blood flow in the intrauterine arteries. After ruling out hypertension/preeclampsia and neurological conditions, ophthalmological evaluation evidenced an uncorrected visual acuity (UCVA) of 20/20, normal colour and Amsler tests, absence of relative afferent pupillary defect, unremarkable anterior segment and normal intraocular pressure in both eyes. Fundoscopy revealed slight congestion of superior and inferior papillary borders in the right eye (OD), whereas in OS evidenced severe congestion and optic disc edema with an inferior peripapillary splinter haemorrhage. Marked venous stasis, tortuosity, perivenular exudates and intraretinal haemorrhages were present. A diagnosis of papillophlebitis was established and a conservative approach was followed maintaining antithrombotic treatment with no additional treatment being urgently started. Fundoscopic lesions and symptoms resolved progressively before the delivery took place and without additional treatment. Nine weeks after the initial presentation the patient gave birth transvaginally without obstetric, systemic or ophthalmological complications. Recurrence of her visual symptoms or fundus lesions did not occur.
The development of papillophlebitis during pregnancy was first reported in the literature in 1961, and although extremely rare, poses additional and important clinical management issues such as the need for initiating treatment, difficulties with diagnostic tests with regards to foetal safety as well as issues with delivery planning. Our case illustrates the tendency observed in two previous case reports, being that pregnancy-associated papillophlebitis tends to occur in 30 year-old patients or older and mainly during the third trimester of pregnancy. Our case provides new insights into the natural history of this entity, as is the first described case in which no additional treatment, such as systemic corticotherapy, was initiated. The distinctive value of our case is describing that the natural tendency of this entity is towards progressive resolution of symptoms and fundoscopic lesions irrespective of wether delivery takes place or not, therefore delivery induction techniques and caesarean section not being indicated solely due to the fact of suffering an episode of papillophlebitis during pregnancy.