1
|
Aldhefeery N, Aldhafiri D, Fathy M, Kumaran S, Abdelbadie M. Bilateral Purtscher-like retinopathy: A case report in a patient with pre-eclampsia and post intrauterine fetal demise. Int J Surg Case Rep 2023; 113:109072. [PMID: 38000143 DOI: 10.1016/j.ijscr.2023.109072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Purtscher's retinopathy is a rare ophthalmic condition with unclear pathogenesis commonly related to trauma and affecting young or middle-aged men. The annual incidence in the UK has been estimated to be 0.24 cases per million. PRESENTATION OF CASE A 29-year-old primigravida female, previously healthy with no antenatal care, was brought to the maternal causality at 36 weeks of gestation as a case of pre-eclampsia and intrauterine fetal demise (IUFD) after a prolonged delivery attempt at home. After delivery, the patient reported bilateral vision loss. On ophthalmic examination, the best-corrected visual acuity (BCVA) was count fingers at 15 cm in both eyes. Dilated fundus exam showed scattered flame-shaped hemorrhage, multiple cotton wool Spots known as Purtscher flecken were seen in the distribution of the radial peripapillary capillary, dot and blot hemorrhage, and macular star in both eyes. The patient was treated with labetalol and magnesium sulphate for systemic control of arterial blood pressure by the obstetrics team, and managed conservatively under ophthalmic observation. Upon five months follow-up, BCVA had improved bilaterally. DISCUSSION Visual changes have been reported in 25 % of patients with preeclampsia. Although most of these changes are transient, some rare sight-threatening eye conditions have been linked to preeclampsia namely Purtscher-like retinopathy. CONCLUSIONS Purtscher-like retinopathy is rarely reported in preeclampsia and after childbirth. Although most of visual changes associated with preeclampsia are transient, urgent ophthalmology consultation is important to rule out serious etiologies such as Purtscher-like retinopathy.
Collapse
Affiliation(s)
- Nora Aldhefeery
- Department of Ophthalmology, Farwaniya Hospital, Ministry of Health, Kuwait.
| | | | - Mohamed Fathy
- Department of Ophthalmology, Farwaniya Hospital, Ministry of Health, Kuwait
| | - Shyji Kumaran
- Department of Ophthalmology, Farwaniya Hospital, Ministry of Health, Kuwait
| | - Mohamed Abdelbadie
- Department of Ophthalmology, Farwaniya Hospital, Ministry of Health, Kuwait
| |
Collapse
|
2
|
Kalavar M, El Khatib B, Suelves AM, Yanoga F. Purtscher-like retinopathy in patients with COVID-19. Am J Ophthalmol Case Rep 2023; 32:101915. [PMID: 37663997 PMCID: PMC10474068 DOI: 10.1016/j.ajoc.2023.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Several ophthalmological complications of coronavirus disease 2019 (COVID-19) involving the anterior and posterior segment have been reported in the literature. We present two patients with Purtscher-like retinopathy presenting with bilateral central vision loss and diffuse peripapillary cotton wool spots extending into the macula bilaterally. Observations In both cases, the patients were diagnosed with COVID-19 within a week of their presentations and had relatively mild courses of COVID-19. In the first case, the patient's vision was hand motion in the right eye and count fingers in the left eye. A broad workup was negative, revealing no concerns for underlying conditions traditionally associated with Purtscher-like retinopathy. Head and neck imaging was also negative for vascular abnormalities. The patient was given a diagnosis of Purtscher-like retinopathy due to COVID-19 infection and was started on 60 mg of oral prednisone. At 4-week follow up, patient's vision had improved to 20/100 in the right eye and 20/80 in the left eye, although she continued to have minimal central vision. The patient continued to have Purtscher flecken in the posterior pole, but the density of the opacities and retinal hemorrhages had significantly improved. In the second case, the patient's past medical history was significant for Huntington's disease and kidney transplant on dialysis but she had not had any ocular issues prior. One week within diagnosis of COVID-19, she presented with a vision of count fingers in the right eye and 20/400 in the left eye. The patient's baseline dose of 5 mg prednisone was increased to 60 mg for 1 week. She received an Ozurdex implant in both eyes. The patient's vision at 9 week follow up improved to 20/40 pinholing to 20/25 in the right eye and 20/200 pinholing to 20/70 in the left eye and dilated exam showed improving edema and improving density of Purtscher-flecken from initial presentation. Conclusions and importance Very few cases of COVID-19 associated Purtscher-like retinopathy have been reported in the literature and all have been reported with serious clinical courses of COVID-19. To the best of our knowledge, these are the first cases to be reported after relatively mild courses of COVID-19 and highlight the importance of including COVID-19 in the differential for Purtscher-like retinopathy.
Collapse
Affiliation(s)
- Meghana Kalavar
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bahaeddin El Khatib
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ana M. Suelves
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Fatoumata Yanoga
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
3
|
Pee XK, Low A, Ab Kahar MEPI, Mohamed SO, Chong YJ. Purtscher-like retinopathy and paracentral acute middle maculopathy following breast filler injection. BMC Ophthalmol 2023; 23:444. [PMID: 37932684 PMCID: PMC10629129 DOI: 10.1186/s12886-023-03186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To report a rare case of pulmonary and ocular complications with visual loss due to bilateral Purtscher-like retinopathy and paracentral acute middle maculopathy (PAMM) following a hyaluronic acid (HA) filler injection to the breast. Systemic and visual recovery was attained following corticosteroid therapy. CASE PRESENTATION A 27-year-old lady presented with painless blurring of vision in both eyes for 2 weeks following hyaluronic acid breast filler injections by a non-medical practitioner. She was initially admitted to the medical ward for diffuse alveolar haemorrhage and altered sensorium. The presenting visual acuity was counting fingers in both eyes. Bilateral dilated fundus examination showed hyperaemic discs, concentric rim of retinal whitening around macula with patches of polygonal-shaped retinal whitening, generalised cotton-wool spots, tortuous veins, and flame-shaped haemorrhages. Spectral-domain optical coherence tomography (SD-OCT) macula revealed hyper-reflective bands at the inner nuclear layer (INL). Fluorescein angiography demonstrated hot discs, delayed arm-to-retina time, arterial filling, and arterio-venous transit time with staining of the vessels at the posterior pole. She was managed with a tapering dose of systemic corticosteroids. The visual acuity improved to 6/12 over 8 weeks with significant anatomical and functional improvement. Dilated fundus examination showed resolution of initial funduscopy findings. The hyper-reflective bands on the OCT had resolved with subsequent thinning of the INL and disorganisation of retinal inner layers. CONCLUSION Filler injections are in increasing demand and are frequently being performed by non-medical practitioners. Visual loss from non-facial HA fillers is rare. Inadvertent entry of HA into a blood vessel may potentially cause systemic and sight-threatening ocular complications. Good anatomical knowledge and proper injection technique are vital in preventing this unfortunate sequela. There are limited reports on successful visual recovery following various treatment approaches and we hope this case provides valuable insights.
Collapse
Affiliation(s)
- Xu Kent Pee
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
| | - Adeline Low
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
| | | | - Shelina Oli Mohamed
- Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
| | - Ying-Jiun Chong
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
| |
Collapse
|
4
|
Srichawla BS, Catton RM, Lichtenberg AA, Henninger N. Clinical characteristics and risk factors for bilateral lateral geniculate body pathology: a systematic review of the literature. Neurol Sci 2023; 44:3481-3493. [PMID: 37086352 DOI: 10.1007/s10072-023-06818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Case presentation of acute onset bilateral painless vision loss caused by bilateral infarction of the lateral geniculate bodies (LGB) and a systematic review of the literature. METHODS A descriptive case report is presented on a 17-year-old female diagnosed with acute pancreatitis who developed acute onset bilateral painless vision loss. A systematic literature review of cases with bilateral LGB lesions was conducted across three electronic databases (PubMed/PubMed Central/MEDLINE, Scopus, and ScienceDirect). The review was conducted in concordance with PRISMA guidelines and prospectively registered on PROSPERO (CRD42022362491). RESULTS The reported 17-year-old female was found to have MRI findings consistent with bilateral hemorrhagic infarction of the LGB and Purtscher-like retinopathy. A systematic literature review of bilateral LGB infarction yielded 23 records for analysis. 19/23 (82.6%) of reported cases occurred in women. Bilateral vision loss was noted in all cases. The average reported age was 27 years old with a range from 2-50. Gastrointestinal pathology (e.g., pancreatitis, gastroenteritis) was present in 8/23 (34.7%) of cases. 8/23 (34.7%) cases had neuroimaging or pathological evidence of hemorrhagic transformation of the infarct. Most cases experienced partial recovery of visual loss; only one case (4.7%) had complete visual recovery. 9/23 (39.1%) cases were reported from the United States and 4/23 (17.3%) from India. CONCLUSIONS Bilateral LGB lesion is a rare cause of vision loss, typically caused by systemic diseases and with female preponderance. Purported pathophysiology relates to increased vulnerability of the LGB to ischemic and metabolic stress.
Collapse
Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A..
| | - Raymond M Catton
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A
| | - Alexander A Lichtenberg
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, U.S.A
| |
Collapse
|
5
|
Woodward R, Zheng Y, Fekrat S. Asymmetric Purtscher-Like Retinopathy Caused by a Hypertensive Emergency and Undiagnosed Type 2 Diabetes. J Vitreoretin Dis 2023; 7:459-462. [PMID: 37706084 PMCID: PMC10496805 DOI: 10.1177/24741264231177130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Purpose: To report a case of Purtscher-like retinopathy (PLR) in the setting of a hypertensive emergency and undiagnosed type 2 diabetes mellitus (DM). Methods: A case was analyzed. Results: A 29-year-old, obese, hypertensive man presented with a 10-day history of progressive vision loss in the left eye with no history of trauma. The visual acuity was 20/25 OD and hand motions OS. A fundus examination showed dilated, tortuous veins; dot-blot and flame hemorrhaging; numerous cotton-wool spots; and polygonal areas of retinal whitening consistent with Purtscher flecken in the right eye and a vitreous hemorrhage in the left eye. The blood pressure was 226/125 mm Hg, and the hemoglobin A1c was 11.6%. The patient's presentation was concerning for a hypertensive emergency and type 2 DM as the etiology for the ocular findings. Conclusions: The presence of one condition in association with PLR does not exclude the presence of another concurrent etiology.
Collapse
Affiliation(s)
- Richmond Woodward
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Yuxi Zheng
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
6
|
Cheng X, Wang F, Li H. Purtscher-Like Retinopathy in a Patient of Atopic Dermatitis Associated with Dupilumab Use: A Case Report. Ocul Immunol Inflamm 2023:1-5. [PMID: 37442378 DOI: 10.1080/09273948.2023.2192277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Purtscher-like retinopathy is a rare and vision-threatening eye disease, which is usually associated with acute pancreatitis, autoimmune diseases, and renal failure. We here reported a case of Purtscher-like retinopathy after dupilumab treatment in atopic dermatitis. CASE REPORT A 48-year-old woman with a history of severe atopic dermatitis developed ocular manifestations after second exposure to dupilumab. Best-corrected visual acuity (BCVA) was count fingers at 2 feet in the right eye and 20/133 in the left eye when she referred to our hospital. Fundus examination demonstrated bilateral serous macular off, thickening of papillomacular bundle, intraretinal hemorrhage, cotton-wool spots and Purtscher flecken surrounding the optic disc. Optical coherence tomography (OCT) angiography showed flow void in the superficial and deep capillary plexuses. And early hypofluorescence corresponding to grayish-white retinal thickening was observed in fundus fluorescein angiography. Laboratory tests revealed hypereosinophilia after symptoms appeared. A diagnosis of Purtscher-like retinopathy was made, which may associate with dupilumab. The patient accepted the treatment with glucocorticoids. At six months follow up, BCVA was 20/40 in the right eye and 20/25 in the left eye. CONCLUSION The Purtscher-like retinopathy we report may be the adverse event of dupilumab. Rare adverse reactions to biologics deserve the attention of ophthalmologists.
Collapse
Affiliation(s)
- Xinyi Cheng
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Bright Eye Hospital, Shanghai, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
7
|
Ameen Ismail A, Tolba HE, Sadek SH, Hatata RM. Purtscher-like retinopathy following coronary artery bypass grafting in an antiphospholipid syndrome patient: a case report. BMC Ophthalmol 2023; 23:197. [PMID: 37142991 PMCID: PMC10157585 DOI: 10.1186/s12886-023-02935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Purtscher retinopathy is a rare occlusive microangiopathy comprising a constellation of retinal signs including cotton wool spots, retinal hemorrhages and Purtscher flecken. While classical Purtscher must be antedated by a traumatic incident, Purtscher-like retinopathy is used to refer to the same clinical syndrome in the absence of trauma. Various non-traumatic conditions have been associated with Purtscher-like retinopathy e.g. acute pancreatitis, preeclampsia, parturition, renal failure and multiple connective tissue disorders. In this case study, we report the occurrence of Purtscher-like retinopathy following coronary artery bypass grafting in a female patient with primary antiphospholipid syndrome (APS). CASE PRESENTATION A 48-year-old Caucasian female patient presented with a complaint of acute painless diminution of vision in the left eye (OS) that occurred approximately two months earlier. Clinical history revealed that the patient underwent coronary artery bypass grafting (CABG) two months earlier and that visual symptoms started 4 days thereafter. Furthermore, the patient reported undergoing percutaneous coronary intervention (PCI) one year before for another myocardial ischemic event. Ophthalmological examination revealed multiple yellowish-white superficial retinal lesions i.e. cotton-wool spots, exclusively in the posterior pole and predominantly macular within the temporal vascular arcades only OS. Fundus examination of the right eye (OD) was normal and the anterior segment examination of both eyes (OU) was unremarkable. A diagnosis of Purtscher-like retinopathy was made based on clinical signs, suggestive history and consolidated by fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) of macula, optic nerve head (ONH) according to the diagnostic guidelines of Miguel. The patient was referred to a rheumatologist to identify the underlying systemic cause and was diagnosed with primary antiphospholipid syndrome (APS). CONCLUSIONS We report a case of Purtscher-like retinopathy complicating primary antiphospholipid syndrome (APS) following coronary artery bypass grafting. This conveys a message to clinicians that patients presenting with Purtscher-like retinopathy should undergo meticulous systemic work-up in order to identify potentially life-threatening underlying systemic diseases.
Collapse
Affiliation(s)
- Ahmed Ameen Ismail
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
| | - Heba Eid Tolba
- Department of Rheumatology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Sherin Hassan Sadek
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Ragai Magdy Hatata
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| |
Collapse
|
8
|
Brummer SR, Joffe JA, Liggett PE. Chemotherapy-Induced Retinopathy in a Diabetic and Hypertensive Patient With Stage 4 Metastatic Pancreatic Adenocarcinoma. J Vitreoretin Dis 2023; 7:242-244. [PMID: 37188211 PMCID: PMC10170613 DOI: 10.1177/24741264231157140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To describe a case of presumed Purtscher-like retinopathy in association with 2 chemotherapies. Methods: A retrospective chart review was performed. Results: A 40-year-old Black woman was diagnosed with pancreatic adenocarcinoma with metastasis to the liver. Cotton-wool spots and microaneurysms (dot/blot hemorrhages) were found on a routine examination 1 month after the patient started gemcitabine/paclitaxel. An increase in cotton-wool spots was noticed after she stopped gemcitabine/cisplatin therapy and started 5-fluorouracil/irinotecan/leucovorin therapy. These retinal changes were observed until the time of death. Conclusions: We believe that the Purtscher-like retinopathy began with gemcitabine toxicity but that the irreversible damage was the result of cisplatin chemotherapy. The patient's uncontrolled hypertension and type II diabetes likely put her at greater risk for developing this retinopathy.
Collapse
Affiliation(s)
- Samantha R. Brummer
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Jonah A. Joffe
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | |
Collapse
|
9
|
Li M, Jin Y, He J. Purtscher-like retinopathy associated with systemic lupus erythematosus treated with rituximab plus low-dose interleukin-2: A case report. Int J Rheum Dis 2023. [PMID: 36806905 DOI: 10.1111/1756-185x.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
Purtscher-like retinopathy, an occlusive microvasculopathy, is a rare and severe ophthalmic complication of systemic lupus erythematosus (SLE) characterized by a sudden loss of vision with retinal whitening, cotton wool spots and minimal intraretinal hemorrhage. Recovery in visual acuity is usually poor even with prompt treatment. This case showed a patient with SLE concurrent Purtscher-like retinopathy treated with rituximab and interleukin-2 (IL-2) with good prognosis. A 16-year-old female with a 2-year history of SLE was admitted because of unrelieved disease activity of SLE when treated with a high dose of corticosteroids and immunosuppressants and she further suffered from reduced visual acuity in both eyes. She was diagnosed with Purtscher-like retinopathy secondary to SLE after ocular examination. Rituximab and low-dose IL-2 for systemic treatment and intravitreal injection of anti-vascular endothelial growth factor antibody to right eye were given. The SLE disease was completely relieved with the sight recovering and no recurrence of Purtscher-like retinopathy was reported during 6-year follow-up. Purtscher-like retinopathy associated with SLE should be treated early and promptly. Rituximab should be considered in SLE patients with Purtscher-like retinopathy who have an incomplete response to initial immunosuppressive therapy and low-dose IL-2 may help induction of clinical remission.
Collapse
Affiliation(s)
- Min Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yuebo Jin
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
10
|
Chiu CY, Cheng CK. Synergic Effect of Intravitreal Bevacizumab and Systemic Corticosteroid in Treating Systemic Inflammatory Response Syndrome (SIRS) Associated Purtscher-like Retinopathy. Ocul Immunol Inflamm 2023; 31:421-425. [PMID: 35404748 DOI: 10.1080/09273948.2022.2026412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To demonstrate the treatment effect of combined intravitreal bevacizumab (IVB) and systemic steroid for systemic inflammatory response syndrome (SIRS)-related Purtscher-like retinopathy (PuR). METHODS Retrospective case report. RESULTS A 19-year-old patient experienced bilateral blurred vision after urinary tract infection-induced SIRS. Typical bilateral PuR was found in fundus examination and fluorescein angiography. Optical coherence tomography (OCT) revealed severe cystoid macular edema (CME) and OCT angiography revealed marked vascular defects in both superficial and deep plexuses. Intravitreal injection of bevacizumab 1.25 mg was first performed in the right eye along with systemic corticosteroid therapy. One week later, marked improvement in visual acuity and CME was noted in the right eye, but not in the non-IVB-treated left eye. IVB was then performed in the left eye and achieved much improvement 8 days later. CONCLUSION This report clearly demonstrated the synergic effect of IVB and systemic steroids for CME on SIRS-related PuR.
Collapse
Affiliation(s)
- Chiung-Yi Chiu
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
11
|
Lee CT, Hsieh TH, Chu CC, Hsu YR, Wang JH, Wang JK, Zhao Z, Chang HT. Hyperbaric oxygen therapy as rescue therapy for pediatric frosted branch angiitis with Purtscher-like retinopathy: A case report. Front Med (Lausanne) 2023; 10:1119623. [PMID: 37138735 PMCID: PMC10149671 DOI: 10.3389/fmed.2023.1119623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Frosted branch angiitis (FBA) is an uncommon uveitis characterized by fulminant retinal vasculitis. Purtscher-like retinopathy (PuR) is a rare retinal angiopathy associated with a non-traumatic etiology. Both FBA and PuR can cause profound visual impairments. Case report We describe the case of a 10-year-old male who presented with sudden bilateral painless visual loss due to FBA with concurrent PuR, with notable viral prodrome 1 month prior to presentation. Systemic investigations revealed a recent herpes simplex virus 2 infection with a high titer of IgM, positive antinuclear antibody (ANA) (1:640), and abnormal liver function tests. After administration of systemic corticosteroids, anti-viral agents, and subsequent immunosuppressive medications, the FBA was gradually alleviated. However, fundoscopy and optical coherence tomography (OCT) revealed persistent PuR and macular ischemia. Hence, hyperbaric oxygen therapy was administered as a rescue strategy, which resulted in gradual bilateral visual acuity improvement. Conclusion Hyperbaric oxygen therapy may be a beneficial rescue treatment for retinal ischemia secondary to FBA with PuR.
Collapse
Affiliation(s)
- Chi-Tai Lee
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Han Hsieh
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chan-Ching Chu
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jia-Horng Wang
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi’an, China
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Hou-Tai Chang
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan, Taiwan
- *Correspondence: Hou-Tai Chang,
| |
Collapse
|
12
|
Alaei R, Shen C, Chan BJ, Martin J. Purtscher-Like Retinopathy Secondary to Medication Induced Calcium-Alkali Syndrome and Acute Pancreatitis in a Pregnant Female. Ocul Immunol Inflamm 2022; 30:1564-1567. [PMID: 33979245 DOI: 10.1080/09273948.2021.1906909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To report a case of Purtscher-like retinopathy secondary to acute pancreatitis caused by medication-induced calcium-alkali syndrome in a pregnant woman. METHODS Case report. RESULTS A 39-year-old 23-week pregnant patient complained of visual disturbances during admission for acute pancreatitis precipitated by calcium-alkali syndrome. History revealed the acute ingestion of over 2,400 mg of elemental calcium from over the counter medication in the background of longstanding use. Visual acuity was counting fingers at 1 foot bilaterally. Posterior segment exam revealed Purtscher-flecken in the posterior pole with scattered dot hemorrhages. Optical coherence tomography (OCT) revealed inner retinal thickening and increased hyper-reflectivity. OCT angiography demonstrated loss of flow primarily in the superficial capillary plexuses. The patient was diagnosed with Purtscher-like retinopathy and observed. Two months follow up revealed resolution of the funduscopic findings and visual acuity improved minimally to 20/200 in the right eye and counting fingers in the left eye. CONCLUSION Common over the counter medication can potentiate a calcium-alkali syndrome capable of causing a Purtscher-like retinopathy.
Collapse
Affiliation(s)
- Ravin Alaei
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carl Shen
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Brian J Chan
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - James Martin
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
13
|
Shroff D, Kumar S, Naidu A, Gupta C. Unilateral Purtscher-like retinopathy post-COVID-19. Indian J Ophthalmol 2022; 70:3710-3712. [PMID: 36190079 PMCID: PMC9789798 DOI: 10.4103/ijo.ijo_1486_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 32-year-old male with no known systemic illness presented with unilateral Purtscher-like retinopathy in his left eye 2 weeks after recovering from a severe COVID-19 infection. Fundus examination revealed areas of intraretinal whitening and few cotton wool spots. Multimodal imaging findings were consistent with embolic occlusion of capillaries seen in Purtscher-like retinopathy. The case highlights the effect of virus-directed coagulation cascade activation leading to unilateral microvasculopathy in our patient. The case adds to the spectrum of COVID-19 retinopathy and presses that retina screening strategies should be established for patients suffering from or recovering from severe COVID-19 infection.
Collapse
Affiliation(s)
- Daraius Shroff
- Vitreoretinal Services, Shroff Eye Centre, New Delhi, India
| | - Sandeep Kumar
- Vitreoretinal Services, Shroff Eye Centre, New Delhi, India,Correspondence to: Dr. Sandeep Kumar, Shroff Eye Centre, A-9, Kailash Colony, New Delhi - 110 048, India. E-mail:
| | - Anushree Naidu
- Retina Department Ahooja Eye and Dental Institute, Gurgaon Haryana, India
| | - Charu Gupta
- Vitreoretinal Services, Shroff Eye Centre, New Delhi, India
| |
Collapse
|
14
|
Rahman EZ, Shah P, Ong JE, Goldberg M, Ong SS. Purtscher-like retinopathy in a patient with COVID-19 and disseminated intravascular coagulation. Am J Ophthalmol Case Rep 2021; 24:101229. [PMID: 34796309 PMCID: PMC8582232 DOI: 10.1016/j.ajoc.2021.101229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To describe a unique case of Purtscher-like retinopathy after a severe, complicated COVID-19 course which included development of disseminated intravascular coagulation (DIC). Observations A 58-year-old male developed blurry vision in the left eye one week after being discharged from the hospital for severe COVID-19 pneumonia and DIC. He had been intubated and ventilated for 5 days. Fundus examination revealed optic nerve hyperemia in the right eye, optic nerve pallor in the left eye, arteriolar attenuation, multiple cotton wool spots and ill-defined areas of retinal whitening in the posterior pole in both eyes. His exam findings were most consistent with Purtscher-like retinopathy in both eyes. Conclusions and Importance While several cases of central retinal artery and vein occlusion have been described in COVID-19 patients thus far, there has not been any reported cases of Purtscher-like retinopathy. To the best of our knowledge, this is the first case of Purtscher-like retinopathy in a patient who developed DIC during a severe COVID-19 infection.
Collapse
Affiliation(s)
- Effie Z Rahman
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Pooja Shah
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Morton Goldberg
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sally S Ong
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
15
|
Smirnova TV, Kozlovskaya NL, Sheludchenko VM. [Ocular manifestations of primary thrombotic microangiopathy]. Vestn Oftalmol 2021; 137:138-144. [PMID: 34726868 DOI: 10.17116/oftalma2021137051138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article reviews literature on ocular manifestations of primary thrombotic microangiopathy. Thrombotic microangiopathy is a clinical and morphological syndrome that characterizes a systemic disseminated lesion of the microcirculatory bed, it is a special type of vascular damage that combines thrombosis and inflammation of the vascular wall leading to occlusion of the vessel lumen, causing ischemic damage to various organs and tissues. The classic types of primary thrombotic microangiopathy are thrombotic thrombocytopenic purpura, shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) and atypical hemolytic uremic syndrome. Thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome are characterized by ischemic damage to the visual organ as a result of suspected thrombotic microangiopathy in the microcirculatory bed of the eye. The clinical picture of ocular manifestations of these diseases is similar, however the damage to the eye in the form of ischemic Purtscher-like retinopathy is more characteristic of atypical hemolytic uremic syndrome, which may be due to chronic uncontrolled activation of the alternative complement pathway in this disorder. Timely initiation of systemic therapy of the underlying disease in most cases leads to complete restoration of visual functions. A thorough ophthalmological examination of patients with these diseases is required.
Collapse
Affiliation(s)
- T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
| | | | | |
Collapse
|
16
|
Benvenuto F, Guillen S, Marchiscio L, Falbo J, Fandiño A. Purtscher-like retinopathy in a paediatric patient with haemolytic uraemic syndrome: A case report and literature review. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:607-610. [PMID: 34756284 DOI: 10.1016/j.oftale.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/14/2020] [Indexed: 06/13/2023]
Abstract
An 8-year-old boy presented with fever, vomits, bloody diarrhoea, and blurred vision. The patient was diagnosed with Haemolytic Uraemic Syndrome (HUS) due to the symptoms and a positive Verotoxin stool test. Funduscopic examination showed retinal involvement in both eyes, peri-papillary paleness, retinal haemorrhages, and soft "Purtscher Fleckens" exudates. A favourable outcome was achieved after hospital admission and systemic treatment. Dialysis treatment was not needed due the preserved diuresis. Although Purtscher-like retinopathy is very uncommon, ocular examination is mandatory in patients with pancreatitis, autoimmune diseases, and thrombotic microangiopathies, such as HUS.
Collapse
Affiliation(s)
- F Benvenuto
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina.
| | - S Guillen
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - L Marchiscio
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - J Falbo
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - A Fandiño
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| |
Collapse
|
17
|
Hernández-Almeida S, Reche-Sainz JA, Ruiz-Arranz C, García-Louro A, Ferro-Osuna M. Purtscher-like retinopathy after a stent implant for the treatment of carotid aneurysm. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:488-491. [PMID: 34479705 DOI: 10.1016/j.oftale.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/15/2020] [Indexed: 10/22/2022]
Abstract
Purtscher retinopathy is an occlusive microangiopathy associated with traumatic causes and usually causes visual impairment. For non-traumatic origins, it is called Purtscher-like retinopathy (PLR). A 26-year-old man reported loss of vision in his left eye after the implantation of a telescoping stent for the treatment of an intracranial carotid aneurysm. The fundus of the eye showed numerous cotton-wool spots and superficial haemorrhages. The spontaneous evolution was favourable, with almost complete resolution, except for an inferior residual scotoma. The appearance of PLR may be associated with the implantation of an endovascular stent for the treatment of intracranial aneurysms.
Collapse
Affiliation(s)
- S Hernández-Almeida
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Reche-Sainz
- Unidad Multidisciplinar de Neurooftalmología, Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - C Ruiz-Arranz
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A García-Louro
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Ferro-Osuna
- Unidad Multidisciplinar de Neurooftalmología, Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
18
|
Akiyama K, Iwasaki Y, Tanaka R. Severe Adult Still's Disease Complicated by Purtscher-Like Retinopathy Treated with Intravenous Pulse Methylprednisolone and Tocilizumab. Case Rep Ophthalmol 2021; 12:531-537. [PMID: 34248587 PMCID: PMC8255712 DOI: 10.1159/000516851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
Adult Still's disease (ASD) is a rare systemic inflammatory disorder in which ocular manifestations have rarely been described. We report a 29-year-old Japanese woman with a rare case of refractory ASD complicated by Purtscher-like retinopathy. She was diagnosed with ASD and started on a high dose of oral prednisolone. Two days after the initiation of the treatment, she presented with blurred vision in the left eye, and the funduscopic examination revealed bilateral Purtscher-like retinopathy. Despite treatment with high-dose oral prednisolone for 2 weeks, she developed macrophage activation syndrome. Considering the severity of ASD, intravenous pulse methylprednisolone therapy and tocilizumab injection were administered. Although all the laboratory data and Purtscher-like retinopathy gradually improved, nerve fiber layer defect (NFLD) in both eyes appeared and visual field defect remained corresponding to the NFLD. In conclusion, Purtscher-like retinopathy might be useful as a poor prognostic factor of ASD, which needs appropriate systemic immunosuppressive treatment. Early detection and long-term follow-up of Purtscher-like retinopathy is important because it has the possibility of developing permanent visual field defect.
Collapse
Affiliation(s)
- Kaho Akiyama
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yukiko Iwasaki
- Department of Allergy and Rheumatology, The University of Tokyo Hospital, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
19
|
Yalinbas D, Bozali E, Vural A, Kocak H, Erdogan H. Purtscher-like Retinopathy Associated with Crimean-Congo Hemorrhagic Fever: A Case Report. Ocul Immunol Inflamm 2021; 30:1016-1019. [PMID: 33428499 DOI: 10.1080/09273948.2020.1841805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe retinal findings and spectral-domain optical coherence tomographic (SD-OCT) features of a patient with Crimean-Congo hemorrhagic fever (CCHF) presenting as Purtscher-like retinopathy. CASE REPORT A 70-year-old woman presented with the emerging bilateral blurring of vision. She had been diagnosed with CCHF one week ago and hospitalized in another hospital for treatment of disease. Fundoscopy of the patient revealed cotton-wool spots, retinal whitening areas, and few retinal hemorrhages in a Purtscher-like configuration in both eyes. Spectral-domain optical coherence tomography revealed inner retinal hyperreflectivity corresponding to the cotton-wool spots in both eyes, and also showed subretinal fluid in the left eye. Without any treatment retinal lesions and inner retinal hyperreflectivity on SD-OCT regressed within one month. CONCLUSION Crimean-Congo hemorrhagic fever is known to cause mild ocular disease, and may also cause Purtscher-like retinopathy. It is important to aware of the ocular findings of CCHF.
Collapse
Affiliation(s)
- Duygu Yalinbas
- Department of Ophthalmology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Erman Bozali
- Department of Ophthalmology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Ayse Vural
- Department of Ophthalmology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Husne Kocak
- Department of Ophthalmology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Haydar Erdogan
- Department of Ophthalmology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| |
Collapse
|
20
|
Benvenuto F, Guillen S, Marchiscio L, Falbo J, Fandiño A. Purtscher-like retinopathy in a paediatric patient with haemolytic uraemic syndrome: A case report and literature review. Arch Soc Esp Oftalmol (Engl Ed) 2020; 96:S0365-6691(20)30427-5. [PMID: 33376025 DOI: 10.1016/j.oftal.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 06/12/2023]
Abstract
An 8-year-old boy presented with fever, vomits, bloody diarrhea, and blurred vision. The patient was diagnosed with haemolytic uraemic syndrome (HUS) due to the symptoms and a positive verotoxin stool test. Funduscopic examination showed retinal involvement in both eyes, peri-papillary paleness, retinal haemorrhages, and soft Purtscher «fleckens» exudates. A favourable outcome was achieved after hospital admission and systemic treatment. Dialysis treatment was not needed due the preserved diuresis. Although Purtscher-like retinopathy is very uncommon, ocular examination is mandatory in patients with pancreatitis, autoimmune diseases, and thrombotic microangiopathies, such as HUS.
Collapse
Affiliation(s)
- F Benvenuto
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina.
| | - S Guillen
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - L Marchiscio
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - J Falbo
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| | - A Fandiño
- Ophthalmology Service - SAMIC Pediatric, Hospital «Prof. Dr. Juan P. Garrahan», Buenos Aires, Argentina
| |
Collapse
|
21
|
Chaili S, Mok A, Adrean SD. Purtscher-like retinopathy following total knee arthroplasty: A report of 2 cases. Am J Ophthalmol Case Rep 2020; 20:100945. [PMID: 33083634 PMCID: PMC7554326 DOI: 10.1016/j.ajoc.2020.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/22/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe two cases of Purtscher-like retinopathy after total knee arthroplasty. Observations Two patients were referred for blurred vision after knee surgery. They received a complete vision examination including slit lamp exam, dilated fundus exam, fluorescein angiogram and optical coherence tomography. Two patients developed Purtscher-like retinopathy after knee surgery. The first was a 58-year-old male who underwent bilateral total knee arthroplasty. The second patient developed an infected joint and subsequently received a total knee arthroplasty revision surgery. Both patients experienced decreased vision and were found to have characteristic findings of Purtscher-like retinopathy including vessel attenuation, cotton wool spots and nerve fiber layer infarcts following their respective operations in the absence of other injury. Conclusions and Importance Purtscher-like retinopathy can occur immediately following total knee arthroplasty. Factors including fatty acid liberation, endothelial damage, aberrant coagulation cascade activation, leukocyte aggregation, embolic vascular occlusion and microinfarction likely contributed to these findings. When patients undergo knee arthroplasty and complain of visual scotomas, the diagnosis of Purtscher-like retinopathy should be considered with careful ophthalmic examination and work-up.
Collapse
Affiliation(s)
- Siyang Chaili
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, 2311 Pierce Ave.Nashville, TN, 37232, USA
| | - Audrey Mok
- Eye Treatment Center, 3900 Long Beach Blvd, Long Beach, CA, 90807, USA
| | - Sean D Adrean
- Retinal Consultants of Orange County, 301 W Bastanchury Rd #285, Fullerton, CA, 92835, USA
| |
Collapse
|
22
|
Escoda T, Seguier J, Swiader L, Briantais A, Sampo M, Harlé JR, Durand JM. [ Purtscher-like retinopathy associated with adult onset still disease: Case report and review of the literature]. Rev Med Interne 2020; 41:279-283. [PMID: 31983549 DOI: 10.1016/j.revmed.2019.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/25/2019] [Accepted: 12/22/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Putscher-like retinopathy is a retinal disease that is similar to the syndrome initially described in 1910 by Purtscher, but occurring in a non-traumatic context. CASE REPORT We describe a case of acute, Putscher-like retinopathy in a 48-year-old woman experiencing adult onset Still's disease. The diagnosis was based on fundus examination and fluorescein angiography. Based on a review of the literature, we discuss the current available data on the pathophysiology of this syndrome and its prognostic significance. The treatment remains controversial. CONCLUSION When visual functional signs appear during adult Still's disease, it is necessary to evoke Putscher-like retinopathy, and to ask for an ophthalmological expertise.
Collapse
Affiliation(s)
- T Escoda
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - J Seguier
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - L Swiader
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - A Briantais
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - M Sampo
- Service d'ophtalmologie, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - J R Harlé
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| | - J M Durand
- Service de médecine Interne, hôpital La Timone, Assistance publique, hôpitaux de Marseille, Aix-Marseille université, 13005 Marseille, France.
| |
Collapse
|
23
|
Smirnova TV, Kozlovskaya NL, Sheludchenko VM, Budzinskaya MV. [Optical coherence tomography angiography in the diagnosis of retinal microangiopathy in atypical hemolytic-uremic syndrome (a case report)]. Vestn Oftalmol 2020; 136:226-234. [PMID: 32880144 DOI: 10.17116/oftalma2020136042226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The article describes a clinical case of acute macular neuroretinopathy and «chronic» paracentral acute middle maculopathy in a patient with atypical hemolytic-uremic syndrome - an orphan disease characterized by systemic thrombosis in the vessels of the microcirculatory bed due to chronic uncontrolled activation of the alternative complement pathway. Optical coherence tomography angiography data confirm the ischemic nature of the disease with localization in the deep vascular plexus of the retina in acute macular neuroretinopathy and in the superficial vascular plexus of the retina in «chronic» paracentral acute middle maculopathy. The use of modern diagnostic methods, including optical coherence tomography angiography, can help improve detection of the pathology and expand its understanding in severe microangiopathic syndromes, which include atypical hemolytic-uremic syndrome.
Collapse
Affiliation(s)
- T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
| | | | | | | |
Collapse
|
24
|
Li B, Li D, Chen Y. Purtscher-like retinopathy presented a honeycomb-like pattern in optical coherence topography angiography. BMC Ophthalmol 2019; 19:232. [PMID: 31752754 PMCID: PMC6868727 DOI: 10.1186/s12886-019-1233-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022] Open
Abstract
Background To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and OCT angiography (OCT-A) findings before and after treatment. Case presentation A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination revealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT presented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and choriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed resolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern turned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the choriocapillaris. Conclusion This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the choriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process.
Collapse
Affiliation(s)
- Bing Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Donghui Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
| |
Collapse
|
25
|
Abstract
The most common ocular manifestation following electric shock injury is the development of cataract. Retinal manifestations can vary from development of macular holes to retinal detachments. Purtscher-like retinopathy following electrical injury has not been reported till date. We hereby present a case of a 19-year-old electrician who presented with grossly reduced vision in the right eye of 2 months following an electric shock. The fundus of the right eye showed macular ischemic degeneration, occluded vessels, cotton-wool spots, and hemorrhages. Optical coherence tomography angiography revealed presence of capillary drop-out in the para-foveal region, which was more pronounced in the deep capillary plexus. Electric shock injury can lead to a clinical picture simulating Purtscher's retinopathy. The electrical injury leads to a more extensive damage to the deep capillary plexus as compared with the superficial plexus.
Collapse
Affiliation(s)
- Anuj Sharma
- Department of Retina Vitreous, Aravind Eye Hospital, S.N. High Road, Tirunelveli, Tamil Nadu, India
| | - Y C Venu Gopal Reddy
- Department of Retina Vitreous, Aravind Eye Hospital, S.N. High Road, Tirunelveli, Tamil Nadu, India
| | - Adheesh P Shetty
- Department of Retina Vitreous, Aravind Eye Hospital, S.N. High Road, Tirunelveli, Tamil Nadu, India
| | | |
Collapse
|
26
|
Abstract
Purtscher’s retinopathy is a microvascular occlusive disease initially described as retinal edema, cotton wool-like exudation, and hemorrhages occurring after severe head trauma. A similar clinical presentation called Purtscher-like retinopathy is associated with systemic diseases instead of trauma. In the present case, ophthalmic eksamination of a patient with complaints of blurred vision related to substance (Bonzai) use revealed bilateral cotton-wool spots. Purtscher-like retinopathy was diagnosed based on fluorescein angiography and optical coherence tomography findings. This is the first case of Purtscher-like retinopathy associated with Bonzai use described in the literature.
Collapse
Affiliation(s)
- Zafer Onaran
- Kırıkkale University Faculty of Medicine, Department of Ophthalmology, Kırıkkale, Turkey
| | - Yaprak Akbulut
- Kırıkkale University Faculty of Medicine, Department of Pediatrics, Kırıkkale, Turkey
| | - Serkan Tursun
- Kırıkkale University Faculty of Medicine, Department of Pediatrics, Kırıkkale, Turkey
| | - Tevfik Oğurel
- Kırıkkale University Faculty of Medicine, Department of Pediatrics, Kırıkkale, Turkey
| | - Nesrin Gökçınar
- Kırıkkale University Faculty of Medicine, Department of Pediatrics, Kırıkkale, Turkey
| | - Ayşegül Alpcan
- Kırıkkale University Faculty of Medicine, Department of Pediatrics, Kırıkkale, Turkey
| |
Collapse
|
27
|
Santamaría Álvarez JF, Serret Camps A, Aguayo Alvarez J, García García O. Optic coherence tomography angiography follow-up in a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome. Eur J Ophthalmol 2019; 30:NP14-NP17. [PMID: 30841747 DOI: 10.1177/1120672119833277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome and the changes seen in the optical coherence tomography angiography before and after treatment with eculizumab. CASE DESCRIPTION A 22-year-old man with an unremarkable medical history presented with acute, bilateral blurred vision and headache of 1-week duration. Best corrected visual acuity of 20/50 and 20/40, respectively, in the patient's right eye and left eye. Funduscopy revealed multiple cotton-wool spots associated with intrarretinal fluid. Swept source optical coherence tomography revealed multifocal retinal detachments with increased choroidal thickness. Optical coherence tomography angiography showed areas of ischemia in both capillary plexus. Due to concurrent symptoms and laboratory analysis, he was diagnosed with atypical hemolytic uremic syndrome and secondary Purtscher-like retinopathy; therefore, treatment with eculizumab was initiated. After 2 months revascularization of the previous ischemic areas was seen in the optical coherence tomography angiography that were correlated with best corrected visual acuity improvement. CONCLUSION Our findings suggest that evaluation of the macular capillary plexus revascularization by optical coherence tomography angiography during the disease could help to predict an improvement of best corrected visual acuity in these patients and the measurement of choroidal thickness could give us information about the resolution of the pathologic process.
Collapse
Affiliation(s)
| | - Anna Serret Camps
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | |
Collapse
|
28
|
Espinosa-Barberi G, Alba Linero C, Llorens Bellés V, Adán Civera A. Multimodal imaging and treatment of Purtscher-like retinopathy. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:45-49. [PMID: 30274765 DOI: 10.1016/j.oftal.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone.
Collapse
Affiliation(s)
- G Espinosa-Barberi
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, España; Escuela de Doctorado y Postgrado, Universidad de Las Palmas de Gran Canaria, Las Palmas, España.
| | - C Alba Linero
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Barcelona, España
| | - V Llorens Bellés
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Barcelona, España
| | - A Adán Civera
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Barcelona, España
| |
Collapse
|
29
|
Smirnova TV, Sheludchenko VM, Kozlovskaya NL, Kazaryan EE, Andzhelova DV, Sherstneva LV, Velieva IA, Kuchieva AM, Akaeva MI. [Ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome (a clinical case study)]. Vestn Oftalmol 2018; 134:215-226. [PMID: 30499520 DOI: 10.17116/oftalma2018134051215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The article presents a clinical observation of ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome - a rare genetic disease characterized by systemic thrombosis caused by uncontrolled activation of alternative complement pathway. A typical manifestation of this ocular lesion in this disease is bilateral Purtscher-like retinopathy. Timely diagnostics of atypical hemolytic-uremic syndrome, including ophthalmologic examination, determines the early start of a highly effective pathogenetic therapy with complement inhibitor eculizumab.
Collapse
Affiliation(s)
- T V Smirnova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V M Sheludchenko
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N L Kozlovskaya
- I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - E E Kazaryan
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - D V Andzhelova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L V Sherstneva
- I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - I A Velieva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A M Kuchieva
- I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - M I Akaeva
- I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| |
Collapse
|
30
|
Sánchez Vicente JL, Castilla Martino M, Contreras Díaz M, Rueda Rueda T, Molina Socola FE, Muñoz Morales A, López Herrero F, Moruno Rodríguez A, Vizuete Rodríguez L, Martínez Borrego A. Purtscher-like retinopathy preceding acute renal failure. Arch Soc Esp Oftalmol (Engl Ed) 2018; 93:198-201. [PMID: 28760405 DOI: 10.1016/j.oftal.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/10/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
CASE REPORT The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISCUSSION Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications.
Collapse
Affiliation(s)
| | | | | | - T Rueda Rueda
- Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | | | | | | | | |
Collapse
|
31
|
Dwivedi A, Dwivedi D, Chalisgaonkar C, Lakhtakia S. Purtscher-like retinopathy: A rare ocular finding in nephrotic syndrome. Oman J Ophthalmol 2018; 11:42-45. [PMID: 29563694 PMCID: PMC5848347 DOI: 10.4103/ojo.ojo_231_2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
In this report, we present a case of Purtscher-like retinopathy in a 12-year-old male child with nephrotic syndrome. He was a known case of steroid-dependent nephrotic syndrome, frequent relapser with spontaneous bacterial peritonitis, who presented with complaints of difficulty in vision in both eyes. The fundus examination showed multiple cotton-wool spots and Purtscher fleckens centered around the optic nerve head with superficial retinal hemorrhages in both eyes. Fluorescein angiography confirmed the diagnosis of Purtscher-like retinopathy.
Collapse
Affiliation(s)
- Anamika Dwivedi
- Department of Ophthalmology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India,Address for correspondence: Dr. Anamika Dwivedi, D2-8, Doctors Colony, Medical College Campus, Rewa - 486 001, Madhya Pradesh, India. E-mail:
| | - Deepak Dwivedi
- Department of Paediatrics, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
| | | | - Sujata Lakhtakia
- Department of Ophthalmology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
| |
Collapse
|
32
|
Ustaoğlu M, Önder F, Solmaz N, Öztürk S, Ayer M. Purtscher-Like Retinopathy Associated with Atypical Hemolytic Uremic Syndrome. Turk J Ophthalmol 2017; 47:348-350. [PMID: 29326853 PMCID: PMC5758771 DOI: 10.4274/tjo.66502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022] Open
Abstract
A 25-year-old woman presented with acute bilateral blurred vision and history of headache, dizziness, and syncope for three days. Her visual acuity was 20/60 in both eyes. Fundoscopy revealed multiple bilateral peripapillary yellow-white patches like cotton wool spots, intraretinal hemorrhages and macular edema. The patient was diagnosed with Purtscher-like retinopathy based on the retinal findings and lack of trauma history. She was urgently admitted to the nephrology clinic due to thrombotic microangiopathy findings (hemoglobinemia, thrombocytopenia, and acute renal failure). After excluding thrombotic microangiopathy, the patient was diagnosed with atypical hemolytic uremic syndrome (aHUS) with the clinical and laboratory findings. Eculizumab treatment was added to hemodialysis and plasmapheresis therapy. Three months after starting treatment, retinal lesions regressed and visual acuity increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of Purtscher-like retinopathy associated with aHUS.
Collapse
Affiliation(s)
- Melih Ustaoğlu
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Feyza Önder
- University of Health Sciences, Haseki Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Nilgün Solmaz
- University of Health Sciences, Haseki Training and Research Hospital, Nephrology Clinic, İstanbul, Turkey
| | - Savaş Öztürk
- University of Health Sciences, Haseki Training and Research Hospital, Nephrology Clinic, İstanbul, Turkey
| | - Mesut Ayer
- University of Health Sciences, Haseki Training and Research Hospital, Hematology Clinic, İstanbul, Turkey
| |
Collapse
|
33
|
Ayhan Z, Kaya SY, Ozcan MA, Saatci AO. Brentuximab vedotin related bilateral Purtscher-like retinopathy unresponsive to pulse steroid therapy and intravitreal aflibercept injection. GMS Ophthalmol Cases 2017; 7:Doc29. [PMID: 29326861 PMCID: PMC5745970 DOI: 10.3205/oc000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We describe a 36-year-old woman with a relapsing Hodgkin's lymphoma who developed a severe bilateral sudden visual loss almost three weeks after the initiation of brentuximab therapy. Ancillary fundus tests yielded bilateral severe retinal arteriolar occlusion 360° and serous macular retinal detachment. No visual improvement could be achieved despite the pulse corticosteroid therapy and a single bilateral intravitreal aflibercept administration cessation of the brentuximab therapy. Unfortunately, she succumbed to respiratory failure almost six weeks after the diagnosis of Purtscher-like retinopathy.
Collapse
Affiliation(s)
- Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sureyya Yigit Kaya
- Department of Haematology-Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehmet Ali Ozcan
- Department of Haematology-Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey,*To whom correspondence should be addressed: Ali Osman Saatci, Department of Ophthalmology, Dokuz Eylul University School of Medicine, Mustafa Kemal Sahil Bul. No. 73, A Blok Daire 9, Narlidere, Izmir 35320, Turkey, E-mail:
| |
Collapse
|
34
|
Ang LJPS, Chang BCM. Purtscher-like retinopathy - A rare complication of acute myocardial infarction and a review of the literature. Saudi J Ophthalmol 2017; 31:250-256. [PMID: 29234228 PMCID: PMC5717495 DOI: 10.1016/j.sjopt.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/10/2017] [Accepted: 05/13/2017] [Indexed: 11/16/2022] Open
Abstract
Purtscher-like retinopathy is an uncommon condition with features similar to Purtscher retinopathy but have non-traumatic causes. Several pathogenic mechanisms have been put forth with differing views on treatment options. We describe for the first time, a case of Purtscher-like retinopathy which developed following a myocardial infarct and a transient ischemic attack. We present a review of the literature on this condition, describing the various clinical presentations, investigation findings, treatment options and prognosis.
Collapse
|
35
|
Oshida E, Machida S, Nishimura T, Sakamoto M. Purtscher-like retinopathy associated with cerebro- or cardiovascular surgery. Am J Ophthalmol Case Rep 2017; 8:62-66. [PMID: 29260120 PMCID: PMC5731709 DOI: 10.1016/j.ajoc.2017.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report the findings in five patients of Purtscher-like retinopathy that developed after cerebro- or cardiovascular surgeries. Observations Three women and two men with a mean age of 56.6 years were studied. They had had cerebro- or cardiovascular disease that was treated by major vascular surgery. Postoperatively, all of the patients developed multiple patches of retinal whitening in the area corresponding to the radial peripapillary capillaries in the posterior pole of the eye uni- or bilaterally. In two patients, the optic nerve head was involved which affected their vision severely. Hematological examinations showed hypercoagulable state after the surgeries. The retinal pathologies abated with time. Conclusions and importance These results indicate that major cardio- or cerebrovascular surgeries can cause Purtscher-like retinopathy. The hypercoagulable state and specific structures of the radial peripapillary capillaries may play a role in pathogenesis of this disease.
Collapse
Affiliation(s)
- Eiki Oshida
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Tomoharu Nishimura
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Masaki Sakamoto
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| |
Collapse
|
36
|
Barreiro-González A, Cerdà-Ibáñez M, Barranco González H, Harto Castaño MÁ, Calvo Penadés I, Senent Peris ML, Azorín Villena I. Purtscher-like retinopathy associated with dermatomyositis and hemophagocytic lymphohistiocytosis. Arch Soc Esp Oftalmol (Engl Ed) 2017; 93:202-205. [PMID: 28571902 DOI: 10.1016/j.oftal.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 01/18/2023]
Abstract
CASE REPORT An 11 year-old girl with progressive muscle weakness due to dermatomyositis and hemophagocytic lymphohistiocytosis in which multiple cotton exudates, venous tortuosity and flame haemorrhages are detected in the funduscopic examination, leading to the diagnosis of Purtscher-like retinopathy. DISCUSSION Purstcher's retinopathy is a microvascular disorder with clinical signs of probable thrombotic origin. Its treatment is controversial, with systemic corticosteroids being the most widespread choice.
Collapse
Affiliation(s)
- A Barreiro-González
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - M Cerdà-Ibáñez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valencia, España
| | - H Barranco González
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Á Harto Castaño
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - I Calvo Penadés
- Servicio de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M L Senent Peris
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - I Azorín Villena
- CIBERER, Unidad de Patología Neuromuscular, Hospital Universitario y Politécnico La Fe, Valencia, España
| |
Collapse
|
37
|
Sampedro López A, Domínguez Moro B, Baltar Martin JM, Garcia Monteavaro C, Barbón García JJ. Ocular involvement in atypical haemolytic uraemic syndrome. ACTA ACUST UNITED AC 2017; 92:594-597. [PMID: 28347544 DOI: 10.1016/j.oftal.2017.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
Abstract
CASE REPORT The case is presented of a young man with an atypical haemolytic-uraemic syndrome (aHUS), complicated with bilateral serous retinal detachment, cotton wool spots, and a branch artery occlusion. Treatment with plasmapheresis, haemodialysis and systemic eculizumab led to the blood and urine parameters returning to normal, as well as resolution of the retinal anomalies. Genetic analysis show both mutations in complement factor H and C3. DISCUSSION Haemolytic-uraemic syndrome (HUS) is a thrombotic microangiopathy characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute renal failure. Atypical HUS is caused by genetic mutation of complement system. Ocular involvement is an unusual manifestation of this rare syndrome.
Collapse
Affiliation(s)
- A Sampedro López
- Servicio de Oftalmología, Hospital San Agustín, Avilés, Asturias, España.
| | - B Domínguez Moro
- Servicio de Oftalmología, Hospital San Agustín, Avilés, Asturias, España
| | - J M Baltar Martin
- Servicio de Nefrología, Hospital San Agustín, Avilés, Asturias, España
| | | | - J J Barbón García
- Servicio de Oftalmología, Hospital San Agustín, Avilés, Asturias, España
| |
Collapse
|
38
|
Ramos de Carvalho JE, Schlingemann RO, Oranje M, Bemelman FJ, van Schooneveld MJ. Reversal of threatening blindness after initiation of eculizumab in Purtscher-like retinopathy secondary to atypical hemolytic uremic syndrome. Int Ophthalmol 2018; 38:399-407. [PMID: 28275964 DOI: 10.1007/s10792-017-0470-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/13/2017] [Indexed: 12/21/2022]
Abstract
Purtscher-like retinopathy, a rare manifestation of systemic thrombotic microangiopathy, is a potentially visually debilitating condition with no effective proven treatment. Distinct pathogenic pathways have been proposed as etiological factors. We revisit the etiology of Purtscher-like retinopathy based on the rapid response and profound visual improvement after initiation of systemic intravenous eculizumab, an inhibitor of the complement cascade, in a patient with Purtscher-like retinopathy secondary to familial atypical hemolytic uremic syndrome (aHUS) due to a mutation in complement factor H. We hypothesize that the efficacy of eculizumab in this patient provides evidence for pathogenic events in the retina similar to those encountered in the renal microvasculature of aHUS patients, namely complement-mediated thromboembolization as a result of activation of the complement cascade in endothelial cells with release of tissue factor and development and amplification of a procoagulant state. To the best of our knowledge, this is the first report in the literature of eculizumab as an effective therapeutic strategy in Purtscher-like retinopathy.
Collapse
|
39
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
40
|
Viola F, Vezzola D, Villani E, Mapelli C, Barteselli G, Ratiglia R. Purtscher-like Retinopathy in Septicemic Disseminated Intravascular Coagulation Associated with Nephrotic Syndrome. Eur J Ophthalmol 2013; 23:601-3. [PMID: 23640504 DOI: 10.5301/ejo.5000290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a case of severe Purtscher-like retinopathy during an episode of septicemic diffused intravascular coagulation (DIC) in a child with severe nephrotic syndrome. METHODS Case report. RESULTS A 5-year-old girl with a history of steroid-sensitive nephrotic syndrome was admitted for worsening symptoms of the systemic disease. Laboratory studies revealed evidence of DIC during an episode of septicemia. Ten days later, she had a sudden and severe bilateral visual loss. Her visual acuity was hand motion in either eye. Fundus examination showed ischemic retinal whitening and retinal hemorrhages. Fluorescein angiography revealed obstruction of arterioles and venules at the posterior pole. Three weeks later, ischemic retinal blanching and hemorrhages resolved in both eyes; visual acuity improved to 20/250 and 20/200 in right and left eye, respectively. No further functional improvement was noted after 3 months, due to diffuse thinning of the inner retina architecture as shown by optical coherence tomography. CONCLUSIONS Purtscher-like retinopathy can occur in patients with septicemic DIC and nephrotic syndrome.
Collapse
|
41
|
Sauer A, Nasica X, Zorn F, Petitjean P, Bader P, Speeg-Schatz C, Lenoble P. Cryoglobulinemia revealed by a Purtscher-like retinopathy. Clin Ophthalmol 2007; 1:555-7. [PMID: 19668536 PMCID: PMC2704529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To demonstrate the importance of collaboration between ophthalmologists and internists. DESIGN Cryoglobulinemia is a systemic vascularite. Ophthalmologic complications are rare and not well known. Purtscher-like retinopathy may occur in this context. CASE REPORT We report the case of a patient who presented a severe visual loss in the course of a hepatitis C. The ophthalmic examination shows a both ischemic and hemorrhagic bilateral retinopathy called Purtscher-like retinopathy. Cryoglobulinemia complicating a hepatitis C was discovered in our patient. CONCLUSIONS This case illustrates a cryoglobulinemia complicating by a Purtscher-like retinopathy. The diagnosis has been possible thanks to collaboration between ophthalmologists and internists. We propose a few hypotheses to explain retinopathy pathogeny.
Collapse
Affiliation(s)
- Arnaud Sauer
- Department of Ophthalmology, Hôpitaux universitaires de Strasbourg, Strasbourg, France;,Correspondence: Arnaud Sauer, Service d’Ophtalmologie, Hôpitaux universitaires de Strasbourg. 1 Place de l’hôpital, BP 426, 67091 Strasbourg Cedex, France, Tel +33 3 88 11 62 58, Fax +33 3 88 11 63 55, Email
| | - Xavier Nasica
- Department of Ophthalmology, Centre hospitalier de Mulhouse, France
| | - Frédérique Zorn
- Department of Cardiology, Hôpitaux universitaires de Strasbourg, France
| | | | - Patrick Bader
- Department of hepatology, Centre hospitalier de Mulhouse, France
| | - Claude Speeg-Schatz
- Department of Ophthalmology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Patrick Lenoble
- Department of Ophthalmology, Centre hospitalier de Mulhouse, France
| |
Collapse
|