Peripartum Decompensation of an Orbital Vascular Malformation Managed With Urgent Postpartum Surgical Decompression.

Authors

Malcolm M Kates, Gerald J Harris

Published in

Ophthalmic plastic and reconstructive surgery. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

A 36-year-old woman at 36 weeks gestation presented with 5 months of pain on upgaze and 2 months of progressive vision loss in the right eye. Examination revealed 20/200 acuity, a relative afferent pupillary defect, proptosis, motility restriction, disc edema, and visual field loss. Noncontrast MRI showed a lobulated superolateral orbital apex mass, with differential diagnosis including an orbital vascular malformation enlarged by gestational hypervolemia versus a hormonally sensitive meningioma. Given severe vision loss and advanced gestational age, induced delivery was performed. Postpartum imaging and rapid partial visual recovery favored a vascular etiology. Because spontaneous resolution could not be reliably timed to prevent permanent damage, endoscopic transethmoidal posterior medial wall decompression was performed, restoring vision to 20/20-1 with subsequent lesion regression and normalization of examination findings by 4 months postpartum. Coordinated obstetric-ophthalmic management achieved excellent maternal and fetal outcomes.

PMID:
42777227
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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