Balasubaramaniam Dharshini, Lott Pooi Wah, Iqbal Tajunisah, Singh Sujaya
Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, Universiti Malaya, Kuala Lumpur, MYS.
Cureus. 2023 Apr 23;15(4):e38033. doi: 10.7759/cureus.38033. eCollection 2023 Apr.
Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.
普尔夏视网膜病变是一种罕见的血管病变，见于有严重创伤史和其他全身性疾病的患者。诊断基于临床依据，严重程度各异。一名41岁男性，患有控制不佳的糖尿病和血脂异常，因糖尿病视网膜病变筛查转诊至眼科。他否认有视力方面的主诉。眼部检查显示相对性传入性瞳孔障碍阴性，双眼视力均为6/6。前段检查未见异常。双眼眼底可见视盘呈粉红色，杯盘比为0.4，视盘周围有火焰状出血。右眼在视网膜1区和2区的颞上弓形区域还可见多个棉絮斑，而左眼在视网膜1区的颞上弓形区域可见单个棉絮斑。此外，未见视网膜栓子、点状出血或硬性渗出，黄斑正常。这些视网膜特征并非糖尿病视网膜病变所特有。其表现类似高血压性视网膜病变，但该患者血压正常。黄斑光学相干断层扫描未显示视网膜内层增厚和高反射性，可排除视网膜静脉阻塞。这促使我们进一步询问病史，患者透露近期因心肌梗死住院，期间接受了7分钟的胸外心脏按压心肺复苏。因此，诊断为双眼普尔夏视网膜病变，患者在门诊接受密切监测。普尔夏视网膜病变仍然是一个诊断难题，在复杂的临床情况下不应被忽视。
