Case Report: Paracentral Acute Middle Maculopathy Associated with Purtscher’s Retinopathy in a Polytrauma Patient

Abstract

Introduction Purtscher’s retinopathy represents multi-level retinal ischemia and can present simultaneously with paracentral acute middle maculopathy (PAMM) in cases of severe trauma. However, there are limited reports of the association of these two conditions. Case Presentation A 21-year-old white male complained of bilateral blurred and washed-out vision after jumping off a 5-story building. He had suffered a traumatic brain injury, pulmonary contusion, and multiple bone fractures. Dilated ophthalmoscopy revealed multiple cotton wool spots and Purtscher flecken throughout the posterior pole with intraretinal hemorrhages in both eyes. Optical coherence tomography revealed a hyperreflective band-like lesion in the inner nuclear layer in both eyes, consistent with PAMM. Optical coherence tomography angiography revealed extensive dropout of the parafoveal deep retinal capillaries, corresponding to the location of lesions on optical coherence tomography. Based on the findings, he was diagnosed with PAMM secondary to Purtscher’s retinopathy. Conclusion Purtscher’s retinopathy and PAMM are conditions associated with retinal ischemia and can present concurrently in a polytrauma patient. Multimodal imaging techniques can be utilized to evaluate the structural changes to the retina and to evaluate the extent of retinal ischemia. There is currently no standardized treatment for Purtscher’s retinopathy or PAMM, and patients should be monitored for spontaneous recovery of vision.