Purtscher-like retinopathy - A rare complication of acute myocardial infarction and a review of the literature

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.

Purtscher-like retinopathy associated with cerebro- or cardiovascular surgery

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.

Purtscher-like Retinopathy as a Rare Presentation of Cryoglobulinemia

Purtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus but is not associated with trauma. We report the case of a 55-year-old male who presented a severe visual loss during course of a hepatitis C infection. Ophthalmic examination indicated peripapillary cotton wool spots and superficial retinal whitening in the macula. Cryoglobulinemia complicating hepatitis C was discovered in this patient. Purtscher-like retinopathy as a rare presentation of cryoglobulinemia should be considered in patients with a history of hepatitis infection.