ANGIOPATHIA RETINAE TRAUMATICA (PURTSCHER): WITH SOME REMARKS ON PIGMENT MIGRATION

Abstract

IHIS very rare condition was first described by Purtscherl in 1910 before the Heidelberg Congress. According to him the fundus change was due to the direct effect of a severe contusion on the head, resulting in a sudden increase of the intracranial pressure, which w.-ourd extend throughl the nerve-head to the retinal laver. Haemorrhaages observed, followed the rupture of the retinal veins, and white opacities resulted from lymphorrhage. Retinal opacities appeared about six days after the injury and they were situated around the disc, especially along the vessel trunks. These opacities might disappear completely or incompletely in the course of weeks or niontlhs. Since that date a few more cases have been added to the literature. Vogt and Kniisel(2) in 1921 were able to collect ten cases affecting tlhirteen eves, including three cases of their own. In reviewing all the cases, Vogt and Kniisel concluded that the white opacities were mainly located on the temporal side, above and below the disc along thie main vessels. IThe disc and the macuLlar region were exempt. 'Phese opacities were round, mostly discrete, but mighlt at times become confluient, of milky to silvery white colour. They were lying in the inner layers of the retina. They appeared to be composed of parallel lines and dots in the direction of nerve fibres in process of absorption. The foci, according to these twNo auithors, were the direct consequence of the trauma, since they were able to observe the typical changes as early as twenty hours after the injury, and as ac result of sudden infiltration of lymph fluid between the retinal elements. TIhe limitans interna was wrinkled. In all their cases there was a crescentic scotoma around the fixation point, which was in continuity with the blind spot. The prognosis as to perfect vision is doubtful. In studying all the cases which have appeared in the literature, I am unable to find a similar case where it is complicated with such pig,ment change as I have observed in the following case. Besides the extensive pigment migration, it presents also several points of interest.