Bilateral doughnut-shaped macular edema in a pregnant woman with neuromyelitis optica spectrum disorders

A 22-year-old female presented with bilateral rapidly progressive vision loss for 1 day. She was 19 weeks pregnant with thalassemia and body mass index of 17.3. Initially, she complained of newly developed blue vision and ocular pain during eye movement. Her vision deteriorated into no light perception in few hours. The pupils were partially dilated and poorly reactive to light. Fundus photos were relative normal but infrared images showed doughnut-shaped perifoveal hyporeflectivity bilaterally, which corresponded to comb-like microcystic macular edema (MME) in the inner nuclear layer on optical coherence tomography angiography (Figure).