Optical coherence tomography angiography characterization of acute and late stage Purtscher retinopathy

Purpose: To report a case of Purtscher retinopathy imaged with optical coherence tomography angiography. Methods: Case-report. Left eye fundoscopic examination in a 21-year old male after a road traffic accident with chest compression revealed multiple peri-papillary cotton-wool spots and intra- and pre-retinal hemorrhages. A diagnosis of Purtscher retinopathy was assumed. Results: In both the superficial and deep retinal plexuses, acute stage optical coherence tomography angiography identified multiple irregular areas of capillary non-perfusion that extended beyond the clinically visible peri-papillary cotton-wool spots. At 5-month follow-up, despite the clearing of visible cotton-wool spots, there were still permanent areas of irregular capillary non-perfusion and inner retina atrophy. These sequelae, along with a decrease in the peri-papillary retinal nerve fiber layer thickness, were consistent with a suboptimal visual outcome and a dense inferior arcuate scotoma. Conclusion: Baseline and follow-up optical coherence tomography angiography was able to detect, quantify, and map focal microvascular abnormalities at the level of the superficial and deep inner retinal vascular plexuses. These lesions were consistent with late stage structural and functional sequelae, conferring them prognostic value.

Optical Coherence Tomography Angiography of Purtscher Retinopathy after Severe Traffic Accident in 16-Year-Old Boy

Purpose. To describe optical coherence tomography (OCT) angiography (OCTA) in a case of Purtscher retinopathy. Methods. A 16-year-old male underwent ophthalmological examination including color fundus photography, spectral domain OCT, OCTA, and microperimetry. Examination was performed 10 days, 1 month, and 6 months after the trauma. Diagnosis was based on the characteristic clinical presentation. Patients. A single patient case. Results. Only the right eye was affected, and all examinations of the left eye were normal. The visual acuity of the right eye was 0.03 (Snellen equivalent) at 10 days and at one month, improving to 0.16 at 6 months. The imaging confirmed the findings of Purtscher retinopathy with ischemic whitening of the retina and retinal hemorrhages and thickened inner retina on OCT. Microperimetry showed reduced sensitivity in the central macula of the right eye. OCTA revealed nonperfusion in both the superficial and the deep retinal capillary plexus of the right eye. Conclusion. The OCTA in traumatic Purtscher retinopathy following traffic accident showed nonperfusion in both the superficial and the deep capillary plexus of the retina. OCTA is a valuable noninvasive diagnostic examination in Purtscher retinopathy, and fluorescein angiography became redundant in this case.

Bilateral severe visual loss in a patient with acute pancreatitis: Purtscher-like Retinopathy

Purtscher retinopathy is a unilateral or bilateral visual loss following acute injury to the thorax or head. It is characterized by large cotton-wool spots, hemorrhages, and retinal edema. Vision loss may be permanent due to isquemia of the retina, and optic atrophy. Is thought to be a result of injury-induced complement ativation causing granulocyte aggregation and leukoembolization. Other conditions may active complement and may produce similar fundus appearance including acute pancreatitis, collagen-vascular disease, childbirth, and amniotic fluid embolism. Herein, we describe a patient with bilateral permanent visual loss following diagnosis of acute pancreatitis.