Purtscher Retinopathy: To Treat or Not to Treat?

Author:

Gil Pedro1,Pires Joana1,Costa Esmeralda2,Matos Rita1,Cardoso Mariana Sá1,Mariano Manuel1

Affiliation:

1. Centro Hospitalar Baixo Vouga, Aveiro - Portugal

2. Centro Hospitalar Universitário de Coimbra, Coimbra - Portugal

Abstract

Purpose To report a case of Purtscher retinopathy and its therapeutic approach. Methods In this observational case report, complete ophthalmologic examination was performed, including best-corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, dilated fundus examination, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), and Humphrey 24–2 visual field testing. Results The patient complained of right eye diminished visual acuity 48 hours after a car accident, with severe thoracic and abdominal blunt trauma but no direct ocular trauma. The BCVA was counting fingers at 1 meter, anterior segment examination was unremarkable, and the fundus showed cotton-wool spots and Purtscher flecken. Macular OCT revealed subretinal fluid with neurosensorial retinal detachment. The FA showed peripapillary and parafoveal leakage and visual field testing presented a central scotoma. We opted for an observation-only approach. Follow-up revealed a progressive reabsorption of the subretinal fluid with complete resolution of the macular neurosensorial retinal detachment after 2 weeks. After 2 months of follow-up, BCVA was 20/25 and the OCT revealed atrophic changes, with no subretinal fluid. The favorable outcome in terms of BCVA persisted at 4 and 6 months follow-up, although the central scotoma did not improve significantly. Conclusions The characterization of both acute and late-stage lesions provides a valuable insight to a better characterization of this rare disease. Despite a favorable response with a conservative therapeutic approach, structural and functional late stage sequelae influence the final visual outcome.

Publisher

SAGE Publications

Subject

Ophthalmology,General Medicine

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