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Prabhu V, Joshi A, Chitturi SP, Yadav NK, Chhablani J, Venkatesh R. Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy. BMC Ophthalmol 2024; 24:137. [PMID: 38532407 DOI: 10.1186/s12886-024-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Purtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the precapillary retinal arterioles. We describe novel optical coherence tomography (OCT) findings of internal limiting membrane (ILM) separation and posterior hyperreflective dots in a case of Purtscher-like retinopathy in this report. METHODS A 33-year-old man with acute pancreatitis and alcohol-induced liver disease presented to the retina department complaining of four days of painless vision loss in both eyes. Both eyes' anterior segment examination and intraocular pressure were normal. Dilated fundus examination of both eyes revealed confluent areas of retinal whitening, hemorrhages, and cotton-wool spots over the posterior pole, indicating Purtscher-like retinopathy. OCT scans through the macula revealed dense inner retinal reflectivity, thickening, and loss of retinal layer stratification, as well as outer retinal layer shadowing and islands of ILM separation, posterior vitreous hyperreflective dots, and minimal subfoveal fluid, all of which corresponded to areas of retinal whitening on fundus photographs. The patient was given a brief course of systemic steroids. RESULTS On the tenth day after the presentation, visual acuity in the right eye had improved to 6/18 and finger counting at 1 m in the left eye. The retinal findings had faded. The retina had reverted to its normal thickness on the OCT scans, with minimal hyperreflectivity remaining. The ILM separation and posterior vitreous hyperreflective dots were no longer present. CONCLUSION Following Purtscher or Purtscher-like retinopathy, we believe inflammation could play a major role in the development of these two novel OCT findings. This case offers an additional perspective on the underlying mechanisms responsible for the retinal manifestations observed in Purtscher or Purtscher-like retinopathy.
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Affiliation(s)
- Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Sai Prashanti Chitturi
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, 15213, Pittsburg, PA, USA
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
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Magnier F, Jawad V, Beal L, Chiambaretta F. [Purtscher's syndrome: Case report]. J Fr Ophtalmol 2023; 46:e368-e371. [PMID: 37598101 DOI: 10.1016/j.jfo.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Affiliation(s)
- F Magnier
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - V Jawad
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - L Beal
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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Purtscher-like Retinopathy in a Patient with Systemic Sclerosis: A Case Report and Narrative Review. Biomedicines 2023; 11:biomedicines11030839. [PMID: 36979818 PMCID: PMC10044861 DOI: 10.3390/biomedicines11030839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Purtscher-like retinopathy (PLR) is an uncommon occlusive microangiopathy associated with various systemic conditions. We report a case of PLR related to severe progressive systemic sclerosis (SSc), an autoimmune disease characterized by widespread angiopathy and fibrosis, in a 44-year-old Caucasian male diagnosed with early diffuse cutaneous systemic sclerosis (dSSc). Upon ophthalmological examination, pathognomonic fundoscopy abnormalities were found. Spectral domain optical coherence tomography (SD-OCT), angio-OCT, and visual field results are documented at initial diagnosis and follow-up visits. The detailed ophthalmological assessment is juxtaposed with rheumatological evaluation and treatment. Current literature on probable pathophysiological mechanisms is reviewed in accordance with the described case. The PLR seems to be connected to severe SSc-related angiopathy initiated by capillary endothelial damage, with ultimate arteriolar precapillary occlusion in the inner retinal layer. Although this is not routinely recommended, we suggest that ophthalmological examinations may be advantageous in patients with SSc, as serious eye pathology may be present despite the lack of symptoms reported by the patient. Patients with PLR require a differential diagnosis and regular follow-up. Proper treatment of the underlying disease may have beneficial effects on the natural course of PLR.
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Khodriss C, Chraibi F, Zarriq S, Bennis A, Abdellaoui M, Benatiya AI. [Choroidal ischemia during Purtscher's retinopathy]. J Fr Ophtalmol 2020; 43:668-670. [PMID: 32631689 DOI: 10.1016/j.jfo.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 10/23/2022]
Affiliation(s)
- C Khodriss
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc.
| | - F Chraibi
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc
| | - S Zarriq
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc
| | - A Bennis
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc
| | - A I Benatiya
- Service d'ophtalmologie, hôpital Omar-Drissi Fès, CHU Hassan-II, Fès, Maroc
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Khatibi A. BRAZILIAN BOOTY RETINOPATHY: PURTSCHER-LIKE RETINOPATHY WITH PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PMMA INJECTION INTO BUTTOCKS. Retin Cases Brief Rep 2018; 12:17-20. [PMID: 27552117 DOI: 10.1097/icb.0000000000000380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report a case of Purtscher-like retinopathy with paracentral acute middle maculopathy preceded by febrile illness after filler injection into the buttock muscles bilaterally for cosmesis to achieve a "Brazilian booty." METHODS Retrospective case report. RESULTS A 35-year-old female presented with febrile illness and then decreased vision after repeat polymethyl methacrylate injections into her buttock muscles in Mexico. Examination was significant for retinal whitening, especially in the perifoveal areas, and intraretinal hemorrhages. Optical coherence tomography and fluorescein angiography imaging were consistent with small-vessel ischemic disease in the retina and choroid. Once systemic infection was ruled out, patient was treated with high-dose intravenous and then oral steroids. Vision recovery was good, with retinal atrophy on optical coherence tomography in the previous areas of retinal whitening. CONCLUSION A Purtscher-like retinopathy with paracentral acute middle maculopathy and loss of vision may occur after filler injection below the neck, not just the face. This is the first report of vision loss caused by filler injected outside the face.
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Affiliation(s)
- Azadeh Khatibi
- Department of Ophthalmology, Southern California Permanente Medical Group, California
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Ting DSJ, Smith J, Talks SJ. Purtscher-like retinopathy associated with squamous cell carcinoma of the cervix. Int Ophthalmol 2017; 38:389-393. [PMID: 28168568 DOI: 10.1007/s10792-017-0461-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/31/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe a previously unreported case of Purtscher-like retinopathy secondary to severe acute renal failure associated with squamous cell carcinoma of the cervix. METHODS This is a case report. RESULTS A 31-year-old female presented with a week history of acute abdominal pain, vomiting and severe renal failure followed by a sudden onset of bilateral visual loss. Vision was hand movement in either eye with central scotoma. Ophthalmic examination demonstrated bilateral retinal thickening and whitening with intraretinal hemorrhages localized to the peripapillary area, consistent with the diagnosis of Purtscher-like retinopathy. Further systemic examination revealed bilateral hydronephrosis secondary to underlying undiagnosed cervical carcinoma. Patient was treated with a short course of high-dose steroids. At 2 months, patient vision remained poor despite the resolution of retinal edema and hemorrhages. CONCLUSIONS This case serves as the first report of Purtscher-like retinopathy secondary to acute renal failure associated with cervical carcinoma, expanding the list of causes of Purtscher's or Purtscher-like retinopathies. In the presence of significant uremia and absence of previously known association, the authors postulate that the sudden surge of uremia causes increase of endothelin-1 (a potent vasoconstrictor), resulting in downstream endothelin-induced vasculopathy with subsequent occlusion of the pre-capillary arteriolar network.
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Affiliation(s)
- Darren Shu Jeng Ting
- Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | | | - Stephen James Talks
- Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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La rétinopathie de Purtscher : apport de la tomographie par cohérence optique (OCT) dans le diagnostic, le suivi et l’évaluation pronostique. J Fr Ophtalmol 2016; 39:e201-e206. [DOI: 10.1016/j.jfo.2015.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/26/2015] [Accepted: 05/15/2015] [Indexed: 11/19/2022]
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Hashim SP, El Shafei M, Al
Ansari ZM. Purtscher’s retinopathy: A case of severe bilateral visual loss due to chest compression. JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2012. [DOI: 10.5339/jemtac.2012.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Lee MY, Park JY, Seo WM. Spontaneously Resolved Purtscher's Retinopathy within 24 Hours: Case Report and OCT Review. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.9.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Young Lee
- Department of Ophthalmology, Dongkang Medical Center, Ulsan, Korea
| | - Jae Yeong Park
- Department of Ophthalmology, Dongkang Medical Center, Ulsan, Korea
| | - Won Moon Seo
- Department of Ophthalmology, Dongkang Medical Center, Ulsan, Korea
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Indirect Traumas Affecting The Posterior Segment. Clin Ophthalmol 2012; 52:167-80. [DOI: 10.1097/iio.0b013e31823bbc64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Giani A, Deiro AP, Sabella P, Eandi CM. Spectral domain-optical coherence tomography and fundus autofluorescence findings in a case of purtscher-like retinopathy. Retin Cases Brief Rep 2011; 5:167-70. [PMID: 25389893 DOI: 10.1097/icb.0b013e3181d42706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE The purpose of this study is to describe spectral domain-optical coherence tomography and autofluorescence images in a case of bilateral Purtscher-like retinopathy. METHODS This is an observational case report of a 31-year-old man suffering with Purtscher-like retinopathy postpancreatitis. RESULTS In the acute phase, spectral domain-optical coherence tomography showed hyperreflectivity in the inner retinal layers, corresponding to cotton-wool exudation as a result of precapillary ischemia. The follow-up using spectral domain-optical coherence tomography showed that the inner retina is the most involved layer by ischemic damage in the acute phase. In the regression phase, signs of suffering in the outer retinal layers became visible as well, although after the resolution of the pathology, there was no evident spectral domain-optical coherence tomography abnormality in the photoreceptors layers. Autofluorescence images after resolution showed hyperautofluorescent vessels affected by ischemia as a possible result of long-lasting retention of intraretinal blood. CONCLUSION Spectral domain-optical coherence tomography and autofluorescence are sensitive and noninvasive imaging modalities to evaluate retinal alterations after Purtscher-like retinopathy. Spectral domain-optical coherence tomography confirms that ischemia causes an alteration primarily in the inner retinal layers, but the process also involves the outer retinal layers.
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Affiliation(s)
- Andrea Giani
- From the *Retina Service, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; the †Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy; and the ‡Department of Clinical Physiopathology, Eye Clinic, University of Torino, Torino, Italy
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Proença Pina J, Ssi-Yan-Kai K, de Monchy I, Charpentier B, Offret H, Labetoulle M. [Purtscher-like retinopathy: case report and review of the literature]. J Fr Ophtalmol 2008; 31:609-13. [PMID: 18772813 DOI: 10.1016/s0181-5512(08)75463-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purtscher's retinopathy is a rare condition, seen in patients with a history of trauma. Purtscher-like retinopathy includes the nontraumatic causes of this retinal disease, which is often misdiagnosed. The diagnosis is based on clinical settings and is supported by intravenous fluorescein angiography. We describe a case of acute, severe retinopathy in a patient experiencing a scleroderma renal crisis. We discuss the pathogeny, prognosis and treatment, which is still widely controversial.
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Affiliation(s)
- J Proença Pina
- Service d'Ophtalmologie, CHU Bicêtre, APHP, Université Paris-Sud, Le Kremlin Bicêtre, France.
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Agrawal A, McKibbin M. Purtscher's retinopathy: epidemiology, clinical features and outcome. Br J Ophthalmol 2007; 91:1456-9. [PMID: 17556428 PMCID: PMC2095457 DOI: 10.1136/bjo.2007.117408] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2007] [Indexed: 11/04/2022]
Abstract
AIMS To study the incidence, systemic associations, presenting features and natural history of Purtscher's retinopathy in the UK and Ireland. METHODS Cases were collected prospectively by active surveillance through the British Ophthalmological Surveillance Unit. Clinical details were obtained using an incident questionnaire, with follow-up at 1 and 6 months. RESULTS Clinical details were obtained for 15 cases over 12 months. These were associated with road traffic accidents in 6 cases, chest compression in 6 cases and acute pancreatitis in 3 cases. All cases were symptomatic and presented with loss of visual acuity, visual field or a combination. Bilateral involvement was noted in 9 cases. The acute retinal signs of cotton wool spots, retinal haemorrhage and Purtscher flecken cleared within 1 month in 26% of eyes and within 6 months in all eyes. The most common chronic signs were optic disc pallor and atrophy of the retinal pigment epithelium. Without treatment, 50% of eyes improved by at least 2 Snellen lines at final follow-up and 23% improved by at least 4 Snellen lines. Only 1 of the 24 eyes had a final acuity worse than that recorded at presentation. CONCLUSION Purtscher's retinopathy is a rare but sight-threatening eye condition, most commonly seen in young or middle-aged men and after trauma. Spontaneous visual recovery of at least 2 Snellen lines is seen in half of the cases.
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Affiliation(s)
- Ashish Agrawal
- External Eye Diseases & Refractive Surgery, Manchester Royal Eye Hospital, Manchester, UK
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Abstract
Purtscher's retinopathy is a rare condition, seen in patients with a history of trauma or other systemic disease. The clinical appearance would suggest embolic occlusion of the pre-capillary arterioles as the most likely pathogenesis, although other factors leading to blood-vessel damage may also contribute. The diagnosis is made on clinical grounds and supported by intravenous fluorescein angiography. Without treatment, the majority of patients recover some of their visual function. Treatment with systemic steroids may improve visual outcome in some patients but at present there is little evidence to support such treatment routinely.
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Affiliation(s)
- Ashish Agrawal
- Department of Ophthalmology, St James's University Hospital, Leeds, United Kingdom
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Lai WW, Chen AC, Sharma MC, Lam DSC, Pulido JS. PURTSCHER-LIKE RETINOPATHY ASSOCIATED WITH ACUTE RENAL ALLOGRAFT REJECTION. Retina 2005; 25:85-7. [PMID: 15655448 DOI: 10.1097/00006982-200501000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wico W Lai
- Vitreoretinal Service, University of Illinois at Chicago Eye and Ear Infirmary, Chicago, Illinois 60612, USA
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Abstract
BACKGROUND Purtscher's retinopathy is accompanied by a distinct loss of vision as a result of severe trauma to the chest or skull. Reports on visual prognosis in the literature are not uniform. PATIENTS The data of 10 patients with Purtscher's retinopathy from the department of Ophthalmology in Freiburg, published data from 55 patients with Purtscher's retinopathy and 20 patients with traumatic retinal hemorrhages taken from the literature were evaluated. RESULTS The average visual acuity of the 10 patients from Freiburg was 0.3 within a short period after the accident and the final average visual acuity was 0.46. The average visual acuity of the 55 patients with Purtscher's retinopathy was 0.21 within a short period after the accident with an average final visual acuity of 0.61. The average visual acuity of the 20 patients with traumatic retinal hemorrhages from the literature was 0.45 within a short period after the accident with an average final visual acuity of 0.74. Therefore the initial and the final visual acuity were better in patients with traumatic retinal hemorrhages compared to patients with Purtscher's retinopathy. CONCLUSION In spite of severe initial retinal findings, the visual prognosis is usually not disappointing. Prognosis of visual acuity was better in patients with traumatic retinal hemorrhages compared to patients with Purtscher's retinopathy.
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Kocak N, Kaynak S, Kaynak T, Oner HF, Cingil G. Unilateral Purtscher-like retinopathy after weight-lifting. Eur J Ophthalmol 2003; 13:395-7. [PMID: 12872799 DOI: 10.1177/112067210301300412] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of Purtscher-like retinopathy after weightlifting. METHODS A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. RESULTS Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. CONCLUSIONS The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinopathy associated with weightlifting.
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Affiliation(s)
- N Kocak
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.
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Flammer J, Pache M, Resink T. Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye. Prog Retin Eye Res 2001; 20:319-49. [PMID: 11286896 DOI: 10.1016/s1350-9462(00)00028-8] [Citation(s) in RCA: 250] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vasospasm can have many different causes and can occur in a variety of diseases, including infectious, autoimmune, and ophthalmic diseases, as well as in otherwise healthy subjects. We distinguish between the primary vasospastic syndrome and secondary vasospasm. The term "vasospastic syndrome" summarizes the symptoms of patients having such a diathesis as responding with spasm to stimuli like cold or emotional stress. Secondary vasospasm can occur in a number of autoimmune diseases, such as multiple sclerosis, lupus erythematosus, antiphospholipid syndrome, rheumatoid polyarthritis, giant cell arteritis, Behcet's disease, Buerger's disease and preeclampsia, and also in infectious diseases such as AIDS. Other potential causes for vasospasm are hemorrhages, homocysteinemia, head injury, acute intermittent porphyria, sickle cell disease, anorexia nervosa, Susac syndrome, mitochondriopathies, tumors, colitis ulcerosa, Crohn's disease, arteriosclerosis and drugs. Patients with primary vasospastic syndrome tend to suffer from cold hands, low blood pressure, and even migraine and silent myocardial ischemia. Valuable diagnostic tools for vasospastic diathesis are nailfold capillary microscopy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The eye is frequently involved in the vasospastic syndrome, and ocular manifestations of vasospasm include alteration of conjunctival vessels, corneal edema, retinal arterial and venous occlusions, choroidal ischemia, amaurosis fugax, AION, and glaucoma. Since the clinical impact of vascular dysregulation has only really been appreciated in the last few years, there has been little research in the according therapeutic field. The role of calcium channel blockers, magnesium, endothelin and glutamate antagonists, and gene therapy are discussed.
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Affiliation(s)
- J Flammer
- University Eye Clinic Basel, Mittlere Strasse 91, CH-4012, Basel, Switzerland.
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Barrett VJ, Collyer-Powell RG. Bilateral pre-retinal macular haemorrhage following blunt head injury. Eye (Lond) 2000; 14 Pt 5:807-8. [PMID: 11116721 DOI: 10.1038/eye.2000.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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