Purtscher-like Retinopathy Research Articles

Dengue Fever Presenting as Purtscher-like Retinopathy

ABSTRACTPurpose: To report the fundus manifestations and spectral-domain optical coherence tomographic (SD-OCT) features of dengue fever presenting as Purtscher-like retinopathy.Methods: Retrospective review of two cases of dengue fever.Results: Color fundus photograph revealed the presence of cotton-wool spots in a Purtscher-like configuration in the posterior pole of all study eyes. SD-OCT demonstrated increased reflectivity signal in the inner retinal layers, and after a variable follow-up period, there was complete disappearance of cotton-wool spots and persistence of the hyperreflectivity signal.Conclusion: We report two unique cases of dengue fever associated with retinal lesions in a configuration of Purtscher-like retinopathy.

Purtscher-like Retinopathy Associated with High Altitude Travel

Purpose To report a case of Purtscher-like retinopathy associated with travel at high altitude. Methods Case report. Results A 67-year-old man presented 2 weeks after acute vision loss in his left eye that occurred while he was hiking in the mountains of South America. Funduscopic examination revealed multiple cotton-wool spots and discrete areas of retinal whitening. Fluorescein angiography demonstrated areas of choroidal fluorescence blocked by retinal whitening, delayed arteriovenous transit time, and late capillary leakage. Spectral-domain optical coherence tomography showed hyperreflectivity in the inner plexiform, inner nuclear, and outer plexiform layers localized to the areas of retinal whitening. These findings were believed to be most consistent with Purtscher flecken, and the patient was diagnosed with Purtscher-like retinopathy. Conclusions Purtscher-like retinopathy may be linked to travel at high altitude through retinal vessel dilation and constriction leading to retinal vasospasm and precapillary arteriole occlusion. This proposed mechanism of pathogenesis suggests that Purtscher-like retinopathy may represent a partial central retinal artery occlusion.

Purtscher-like retinopathy in a 56-year-old Thai female with anti-glomerular basement membrane glomerulonephritis

A 56-year-old Thai female was referred to Naresuan university hospital with anemia and pitting edema both legs. She had underlying diseases of hypertension, hypercholesterolemia and chronic renal failure with anemia. Before her referral, she was treated by an internist at a provincial hospital. With deterioration of creatinine level and anemic symptom, she was advised to see a nephrologist for the diagnosis of causative pathology and treatment. The reevaluation of chronic renal failure was done. The results of laboratory investigation were creatinine level of 2.42 mg/dl, blood urea nitrogen (BUN) 44 mg/dl and the urinalysis found microscopic hematuria. Further evaluations for hematuria ; vaginoscopy, cystoscopy and ultrasonography of genitourinary system, were performed consequently but all investigations were unremarkable. Then, renal biopsy was done with the result of anti-glomerular basement membrane glomerulonephritis. The hemodialysis and total plasma exchange were done several times to reduce the antibody of anti glomerular basement membrane level.During her admission, she complained of sudden blurred vision both eyes after the ninth total plasma exchange. She has no previous ocular problems nor physical trauma. The ocular examination showed visual acuity of counting fingers both eyes. Anterior segment was unremarkable for her age. The posterior segments showed retinal thickening around the posterior poles with clear intervening zones both eyes with some intraretinal hemorrhage which was compatible with Purtscher-like retinopathy by clinical. The pathogenesis of Purtscher-like retinopathy was investigated with negative results. The counseling was done and the treatment of observation was chosen by the patient and her family. Then she was discharged and followed up at out patient unit of ophthalmology department, Naresuan university hospital.
 
 Conclusion: The Purtscher-like retinopathy is a rare ocular disease with variable treatment strategies and outcomes. In complicated case without obvious causes, the pathogenesis of the disease should be investigated which directed to the proper treatment and better visual outcome.

Bilateral Purtscher-Like Retinopathy With Profound Macular Ischemia and Vision Loss in Severe Pre-Eclampsia

Purtscher-like retinopathy is an extremely rare condition in patients with pre-eclampsia. The bilateral vision loss as seen in the current case is infrequent, but devastating. Our patient is a 27-year-old healthy primigravida patient with severe pre-eclampsia undergoing uncomplicated cesarean section due to abnormal kidney function and worsening hypertension. Postoperatively, she developed Purtscher-like retinopathy with profound macular ischemia and count-finger only vision. Neuroimaging was unrevealing. Her postoperative course was significant for hyponatremia, acute kidney injury, ileus, pancreatitis, leukocytosis, and postoperative fevers with suspected septic pelvic thrombophlebitis. The resultant visual acuity overall improved, but remained limited to 20/150 and 20/250 at 3 months postpartum. Purtscher-like retinopathy in the setting of pre-eclampsia can result in vision loss even in the absence of findings on neuroimaging or presence of HELLP syndrome. J Clin Gynecol Obstet. 2016;5(3):97-99 doi: http://dx.doi.org/10.14740/jcgo410w

Bilateral tractional retinal detachment in a patient with hemolytic-uremic syndrome

Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy characterized by hemolytic anemia, acute kidney injury, and thrombocytopenia. Ophthalmic manifestations of HUS range from mild, including scattered intraretinal hemorrhages, to severe, including a Purtscher-like retinopathy and iris and optic disk neovascularization (NVD). We report the case of a 23-month-old girl with severe HUS who presented with bilateral dense vitreous hemorrhage. During vitrectomy, optic disk neovascularization and funnel-shaped, tractional detachments of both retinas were observed. To our knowledge, this is the first reported case of tractional retinal detachment in the context of HUS.

Purtscher-like retinopathy.

Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis. Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots. Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications.

Purtscher-Like Retinopathy and Diffuse Alveolar Hemorrhage Caused by Soft Tissue Injection for Gluteal Augmentation.

PurposeTo describe a rare occurrence of acute vision loss and diffuse alveolar hemorrhage following a treatment of injectable gluteal cosmetic filler.Patient and methodsA 20-year-old female underwent a cosmetic injection of unknown components for gluteal augmentation. Within hours she developed progressive shortness of breath secondary to diffuse alveolar hemorrhage. She presented to ophthalmology 6 weeks later with a history of bilateral decreased vision. Clinical examination revealed cotton wool spots and retinal hemorrhages. Fluorescein angiography demonstrated macular vascular pruning and an enlarged foveal avascular zone.ResultsThe patient was observed and vision did not improve after 8 months of follow-up.ConclusionThese findings were attributed to a Purtscher-like retinopathy secondary to systemic inflammation induced by the filler and/or direct microembolization of the injected material or fat. To the best of the authors’ knowledge, this is the first documented case of diffuse alveolar hemorrhage and ischemic bilateral vision loss in a patient undergoing gluteal augmentation with dermal filler.

Purtscher-like Retinopathy in Systemic Lupus Erythematosus

To investigate clinical characteristics of Purtscher-like retinopathy and its clinical implications among patients with systemic lupus erythematosus (SLE). Observational case series. setting: Tertiary medical center. patient population: Patients with SLE who were diagnosed with Purtscher-like retinopathy between 2002 and 2013. observation procedures: Assessment and follow-up in the ophthalmology department. main outcome measure: Visual acuity and funduscopic examination at presentation and at 6 month follow-up, with analysis of the association between Purtscher-like retinopathy and other systemic involvement of SLE and overall disease activity. Among 5688 patients with SLE evaluated, 8 cases of Purtscher-like retinopathy were diagnosed. Typical fundus abnormalities included Purtscher flecken, cotton-wool spots, retinal hemorrhages, macular edema, optic disk swelling, and a pseudo-cherry red spot. Fluorescein angiography abnormalities included areas of capillary nonperfusion corresponding to the retinal whitening, late leakage, peripapillary staining, precapillary occlusion, and slower filling of vessels. The prevalence of central nervous system lupus was significantly higher among those with Purtscher-like retinopathy (6/8) than among 240 patients randomly sampled from those without Purtscher-like retinopathy. A very high SLE Disease Activity Index (≥20) was present in all 8 patients with Purtscher-like retinopathy. All patients received corticosteroids combined with immunosuppressants. For the majority of patients, optic atrophy developed during follow-up with persistent low visual acuity. As a rare and severe ophthalmic complication of SLE, Purtscher-like retinopathy was associated with central nervous system lupus and highly active disease. Visual acuity recovery was usually poor despite prompt treatment.

A difficult case of juvenile dermatomyositis complicated by thrombotic microangiopathy and purtscher-like retinopathy

Juvenile dermatomyositis (JDM) is a multisystem disease of uncertain origin resulting in chronic muscle and skin inflammation. Disease’s complications are calcinosis and cutaneous ulcerations, lipodystrophy, joint contractures, interstitial lung disease, cardiac involvement, digestive and central nervous system vasculitis.

Purtscher-like Retinopathy Associated with Systemic Lupus Erythematosus

Purpose: To report on clinical manifestations of Purtscher-like retinopathy (PLR) associated with systemic lupus erythematosus (SLE) and visual outcomes.Methods: We performed a retrospective cohort study of 11 patients (21 affected eyes) with PLR in SLE.Results: All patients were treated with systemic corticosteroids ± immunosuppressive agents. Ocular therapy included intravitreal injections with bevacizumab in 18/21 eyes and posterior sub-Tenon injections with triamcinolone acetonide 13/21 eyes. Panretinal photocoagulation (PRP) was performed in 19/21 eyes and pars plana vitrectomy was required in 5/21 eyes. Visual improvement was found at follow-up of 3 and 6 months (p = 0.05). Poor visual outcome was associated with presence of neovascularizations at onset (p = 0.009), development of vitreous hemorrhage during PRP (p = 0.015), and active status of SLE after onset of PLR (p = 0.029).Conclusions: PLR might manifest as a devastating complication of SLE. We recommend treating any systemic activity of SLE and starting an early ocular treatment.

Is There a Role for Intravitreal Triamcinolone Acetonide Injection in the Treatment of Purtscher-Like Retinopathy? Report of Two Cases

We hereby described two cases with unilateral Purtscher-like retinopathy. The first case occurred following an uneventful spontaneous vaginal delivery. The second case had no discernable cause despite having meticulous systemic work-up. Both eyes had low presenting visual acuity of hand movements and 20/200 consecutively. We elected to inject 1 mg triamcinolone acetolamide in-travitreally for the treatment. Though, there was some subjective visual and clinical improvement within time in both patients, we were not convinced that intravitreal injection was superior to no treatment approach.

Purtscher-like retinopathy associated with dermatomyositis

BackgroundTo report a rare case of bilateral Purtscher-like retinopathy in a Chinese female patient with dermatomyositis.Case presentationAn 18-year-old woman with lower extremity muscle weakness was admitted due to decreased vision of both eyes for two weeks. Ophthalmic examination revealed violaceous eruption on eyelids with swelling. Ocular fundus examination revealed multiple cotton wool spots and Purtscher flecken, and intra-retinal haemorrhages with pseudo-cherry red spot. The erythrocyte sedimentation rate, C-reactive protein, lactate dehydrogenase and creatine kinase was measured and found to be increased. A diagnosis of Purtscher-like retinopathy associated with dermatomyositis was made and the patient was treated with corticosteroids.ConclusionAlthough dermatomyositis is a rare cause of Purtscher-like retinopathy, it is important to keep in mind that systemic associations such as dermatomyositis should be ruled out in such patients.

Purtscher-like Retinopathy in Septicemic Disseminated Intravascular Coagulation Associated with Nephrotic Syndrome

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. Case report. 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. Purtscher-like retinopathy can occur in patients with septicemic DIC and nephrotic syndrome.

Development of Purtscher-like retinopathy after pre-eclampsia combined with acute pancreatitis

Visual disturbances are common among women with pre-eclampsia. The obstetricians should have an understanding of the various conditions associated with visual impairments. We report a case of Purtscher-like retinopathy developed after pre-eclampsia combined with acute pancreatitis. A 33-year-old primigravida with twin pregnancy was admitted to the department of obstetrics and gynecology for preterm labor and pre-eclampsia at 36+4 weeks gestation. After a cesarean section, she complained of abdominal pain and visual acuity loss. She was diagnosed with Purtscher-like retinopathy combined with acute pancreatitis after ophthalmologic examination and an abdominal computed tomography scan. Purtscher-like retinopathy, most often observed after trauma, is very rare in pre-eclampsia. In addition, while visual disturbances from other conditions are transient, it can result in persistent visual impairments. Thus, when a patient with pre-eclampsia complains of visual problems for a long period of time, obstetricians should consider an ophthalmologic evaluation and treatments during the earliest stage of the disease.

PURTSCHER-LIKE RETINOPATHY ASSOCIATED WITH PEMPHIGUS VULGARIS

To report a case of Purtscher-like retinopathy associated with pemphigus vulgaris. Case report of a 25-year-old Hispanic male who was referred for sudden and severe reduction of vision from his right eye shortly after an exacerbation of pemphigus vulgaris. Fundus examination of the right eye revealed severe macular edema, nerve fiber layer infarcts, flame-shaped hemorrhages, and venous dilation. Fluorescein angiography and optical coherence tomography findings of flecken, ischemia with subsequent nerve fiber layer atrophy, and capillary leakage were consistent with Purtscher-like retinopathy. The patient was treated with 5 consecutive monthly intravitreal injections of 0.5 mg of ranibizumab. Visual acuity improved with resolution of macular edema, and the patient was started on systemic mycophenolate mofetil. Continued ocular stability was achieved with 11 subsequent intravitreal injections over the following 2 years. Purtscher-like retinopathy may have been associated with pemphigus vulgaris through a complement activation process that is previously undescribed. Retinal findings were successfully mitigated with the use of intravitreal anti-vascular endothelial growth factor therapy.

Purtscher-like retinopathy in association with metastatic pancreatic adenocarcinoma and capecitabine therapy.

To report a case of Purtscher-like retinopathy in association with capecitabine chemotherapy for metastatic pancreatic adenocarcinoma. Case report. Bilateral retinal hemorrhages and cotton-wool spots in a predominantly juxtapapillary distribution were observed coincident with decreased vision. There was gradual improvement of the retinopathy and patient's vision over several months until the time of death. Metastatic pancreatic cancer and capecitabine, a fluoropyrimidine chemotherapeutic agent, are a rare cause of Purtscher-like retinopathy.

Visual Disturbances in (Pre)eclampsia

This review aims to summarize existing information concerning visual disturbances in (pre) eclampsia that have been described in the literature. Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Visual disturbances in (pre)eclampsia seem to be frequent phenomena. Therefore, the obstetrician/gynecologist may encounter women with serious, and sometimes debilitating, pathology of the visual pathways. Established ophthalmic entities associated with (pre)eclampsia are cortical blindness, serous retinal detachment, Purtscher-like retinopathy, central retinal vein occlusions, and retinal or vitreous hemorrhages. Ensuing visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia, and scotomata, including homonymous hemianopsia. In general, aside from lowering the blood pressure and preventing (further) seizures with magnesium sulfate, no specific therapy seems indicated for (pre)eclamptic women who experience visual changes. Although in most cases visual acuity returns to normal within weeks to months after the onset of symptoms, rarely permanent visual impairment can occur. Health care providers such as emergency room physicians, obstetricians, family physicians, neurologists, and ophthalmologists should be aware that acute onset of visual symptoms in pregnant women can be the first sign of (pre)eclampsia. Given that visual changes are a diagnostic criterion for severe preeclampsia, obstetricians should appreciate the significance of these changes and discuss appropriate diagnostic options with the ophthalmologist. Affected women can be reassured that most cases are transient. Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians After completing this CME activity, obstetricians and gynecologists should be better able to classify visual disturbances at an early stage during pregnancy, interpret acute onset of visual disturbances as the first sign of preeclampsia, and evaluate possible residual visual symptoms during follow-up.

Thrombotic Microangiopathy and Purtscher-like Retinopathy as a Rare Presentation of Juvenile Dermatomyositis

Juvenile dermatomyositis is a rare systemic vasculopathy that may sometimes present with acute complications. We report here the case of a 7-year-old boy with severe dermatomyositis associated with thrombocytopenia and blurry vision. The presence of schistocytosis and the secondary occurrence of hemolytic anemia were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Further investigations demonstrated the association of TTP with muscular microangiopathy and Purtscher-like retinopathy. Retinal and hematologic involvements dramatically improved after the initiation of plasma exchange in emergency. This report emphasizes that early recognition of TTP and prompt plasmapheresis are important in a child with severe juvenile dermatomyositis associated with thrombocytopenia.

Purtscher-like retinopathy and primary hypereosinophilic syndrome association.

The purpose of this study was to describe a patient who presented with a Purtscherlike retinopathy and subsequent diagnosis of primary hypereosinophilic syndrome. Observational case report. A 39-year-old woman presented with a 10-day history of blurry vision and urticarial skin rash. Retinoscopic examination demonstrated bilateral cotton wool spots in the posterior pole, Purtscher flecken, and intraretinal hemorrhages. Workup included a complete history and systemic physical examination, fluorescein angiography, serum laboratory evaluation, magnetic resonance imaging of brain and orbits, pathologic analysis of skin and bone marrow biopsies, flow cytometry, and cytogenetic testing. The diagnosis given to this patient was primary hypereosinophilic syndrome. Review of the literature reveals one previous report of this association. The differential diagnosis of Purtscher retinopathy should include hypereosinophilic syndrome.

HELLP Syndrome Complicated with Postpartum Subcapsular Ruptured Liver Hematoma and Purtscher-Like Retinopathy

Purtscher's retinopathy is usually associated with trauma, acute pancreatitis, vasculitis, lupus, and bone fractures. It was rarely described postpartum in patients with preeclampsia as well as associated with HELLP syndrome. We present a case of a multiparous patient aged 44 with severe preeclampsia and postpartum HELLP syndrome complicated with Purtscher-like retinopathy and large ruptured subcapsular liver hematoma that required emergency abdominal surgery after premature delivery of a dead fetus. Postsurgical outcome was favorable regarding both liver function and visual acuity.