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Purpose: To describe a case of transient visual dysfunction in the postpartum period associated with supernumerary macular vessels and to highlight the role of systemic and ocular hemodynamic normalization in achieving full symptomatic resolution.

Methods: A 23-year-old postpartum woman presented with acutely decreased visual acuity in the right eye (20/30) following significant systemic stress. Clinical findings included hypertension (180/100 mmHg) and tachycardia (110 BPM). Evaluation included SD-OCT, autofluorescence, fluorescein angiography (FA), microperimetry, and Humphrey 24-2 perimetry. MRA of the brain and orbits was performed to exclude vascular malformations. Management focused on collaborative systemic and ocular hemodynamic stabilization.

Results: Retinal imaging showed preserved foveal contours without edema or ischemia, though FA revealed supernumerary macular vessels with abnormal parafoveal trajectory and dense arborization in the inferior macular region. Microperimetry and 24-2 perimetry confirmed corresponding central and paracentral scotomata. Following normalization of blood pressure (120/70 mmHg) and reduction of intraocular pressure (19 to 11 mmHg) via dorzolamide hydrochloride 2%, the patient’s BCVA restored to 20/20. Critically, the patient reported complete subjective recovery, which was objectively confirmed by microperimetry showing the total resolution of previous central scotomata.

Conclusion: We report an instance where supernumerary macular vessels - an anatomical variant- transitioned from asymptomatic to functionally pathological due to postpartum systemic stress. The microperimetry-documented resolution of central scotomata following hemodynamic stabilization proves that functional deficits in these patients can be entirely reversible.