Acute Macular Neuroretinopathy (AMN) following Ergotamine intake in the Postpartum Period: A Case report from Conakry’s Medical Ophthalmologic Center

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.