Case Report: Purtscher Retinopathy Following Subarachnoid Hemorrhage and Femur Fracture
Keywords:
Purtscher retinopathy, traumatic retinopathy, occlusive microvasculopathy, long bone fractureAbstract
Purtscher retinopathy is a rare microvasculopathy which occurs following trauma. Clinical presentation consists of cotton wool spots, retinal hemorrhages, and Purtscher flecken within the posterior pole. A similar display of findings has been associated with a heterogenous group of systemic disorders, but the classification of Purtscher-like retinopathy is reserved for these non-traumatic etiologies. Although the pathogenesis remains to be fully understood, clinical and experimental evidence implicate an occlusive vasculopathy of the precapillary arterioles. Clinical presentation resolves in the months following trauma; however, visual prognosis is variable. There are presently no evidence-based treatments available for Purtscher retinopathy.
References
Miguel AI, Henriques F, Azevedo LF, Loureiro AJ, Maberley DA. Systematic review of Purtscher’s and Purtscher-like retinopathies. Eye (Lond). 2013;27(1):1-13. doi: 10.1038/eye.2012.222 https://www.nature.com/articles/eye2012222.pdf?origin=ppub
Gil P, Pires J, Costa E, Matos R, Cardoso MS, Mariano M. Purtscher retinopathy: to treat or not to treat? Eur J Ophthalmol. 2015 Oct 21;25(6):e112-5. doi: 10.5301/ejo.5000623. PMID: 25982208. https://pubmed.ncbi.nlm.nih.gov/25982208/
Elliot D, Papkostas TD. Traumatic Chorioretinopathies. In: Schachat AP, Sadda SR, Hinton D, et al, Ryan’s Retina. Sixth edition. Elsevier. 2018;94:1757-1770. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323401975000943?scrollTo=%23hl0000504
Hsu J, Regillo CD. Distinct Trauma with Posterior Segment Effects. In: Yanoff M, Ophthalmology. Fifth edition. Elsevier. 2019;6.44:678.682.e1. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323528191003224?scrollTo=%23top
Agrawal A, McKibbin MA. Purtscher's and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006;51(2):129-136. doi:10.1016/j.survophthal.2005.12.003 https://pubmed.ncbi.nlm.nih.gov/16500213/
Agrawal A, McKibbin M. Purtscher's retinopathy: epidemiology, clinical features and outcome. Br J Ophthalmol. 2007;91(11):1456-1459. doi:10.1136/bjo.2007.117408 https://pubmed.ncbi.nlm.nih.gov/17556428/
Agarwal A. Traumatic Retinopathy. In: Agarwal A, Gass’ Atlas of Macular Diseases. Fifth edition. Elsevier. 2012;8:713-753. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781437715804000082?scrollTo=%23top
Ortmaier R, Resch H, Stieböck C, Stundner O, Arlt EM. Purtscher's retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female - report of a rare case and review of the literature. BMC Musculoskelet Disord. 2014;15:42. doi:10.1186/1471-2474-15-42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936909/
Gomez-Ulla F, Fente B, Torreiro MG, Salorio MS, Gonzalez F. Choroidal vascular abnormality in Purtscher's retinopathy shown by indocyanine green angiography. Am J Ophthalmol. 1996;122(2):261-3. doi: 10.1016/s0002-9394(14)72020-3. PMID: 8694097. https://www.sciencedirect.com/science/article/pii/S0002939414720203?via%3Dihub
Chuang EL, Miller FS 3rd, Kalina RE. Retinal lesions following long bone fractures. Ophthalmology. 1985;92(3):370-374. doi:10.1016/s0161-6420(85)34023-x https://www.sciencedirect.com/science/article/abs/pii/S016164208534023X
Behrens-Baumann W, Scheurer G, Schroer H. Pathogenesis of Purtscher's retinopathy. An experimental study. Graefes Arch Clin Exp Ophthalmol. 1992;230(3):286-291. doi:10.1007/BF00176306 https://link.springer.com/content/pdf/10.1007/BF00176306.pdf
Mellor A, Soni N. Fat embolism. Anaesthesia. 2001;56:145-154. doi.org/10.1046/j.1365-2044.2001.01724.x https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2044.2001.01724.x
Kindler CH, Evgenov OV, Crawford LC, Vazquez R, Lewis JM, Nozari A. Anesthesia for Orthopedic Surgery. In: Gropper M, Miller's Anesthesia. Ninth edition. Elsevier. 2020;64: 2071-2101. https://www.clinicalkey.com/#!/content/book/3-s2.0-B978032359604600064X?scrollTo=%23hl0001376
Harrison TJ, Abbasi CO, Khraishi TA. Purtscher retinopathy: an alternative etiology supported by computer fluid dynamic simulations. Invest Ophthalmol Vis Sci. 2011;
(11): 8102–8107. https://iovs.arvojournals.org/article.aspx?articleid=2186840
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