Acute Macular Neuroretinopathy (AMN) following Ergotamine intake in the Postpartum Period: A Case report from Conakry’s Medical Ophthalmologic Center
Fadima Tamin Hann1, Mahmoud Anis2, *, Sonassa Diané1, Mohamed Habib Diané1
Identifiers and Pagination:Year: 2023
E-location ID: e18743641273314
Publisher ID: e18743641273314
Article History:Received Date: 03/08/2023
Revision Received Date: 25/09/2023
Acceptance Date: 03/10/2023
Electronic publication date: 10/11/2023
Collection year: 2023
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
We present a clinical case of postpartum acute macular neuroretinopathy (AMN) and describe clinical characteristics and subsequent pathophysiology.
A twenty-seven-year-old woman previously diagnosed with chronic hypotension developed acute paracentral scotomas in the left eye following an uncomplicated delivery. Best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed flat, well-demarcated, reddish parafoveal lesions in the left eye.
Corrected visual acuity was 20/20 in both eyes. On fundus examination, well-defined, reddish parafoveal abnormalities were seen in the left eye. Multimodal imagining demonstrated a wedge-shaped defect on near-infrared imaging (NIR), co-located with altered external retinal layers on spectral-domain optical coherence tomography (SD-OCT). Optical coherence tomography angiography (OCTA) demonstrated the presence of non-perfused deep capillary plexuses and choriocapillaris. Detailed investigation disclosed that 200 micrograms of ergotamine had been taken to avoid postpartum hemorrhage. Three months follow-up, a reduction in scotoma was reported.
SD-OCT demonstrated reflectivity defect remediation in the outer retinal layers, and OCTA revealed attenuation of vascular flow vacuity.
In brief, AMN in the post-partum setting remains exceptionally high. Clinicians must be mindful of this feature and take care when using ergotamine in women with added AMN risks, notably hypotension.