Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, 15213, Pittsburg, PA, USA.
BMC Ophthalmol. 2024 Mar 27;24(1):137. doi: 10.1186/s12886-024-03413-w.
Purtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the precapillary retinal arterioles. We describe novel optical coherence tomography (OCT) findings of internal limiting membrane (ILM) separation and posterior hyperreflective dots in a case of Purtscher-like retinopathy in this report.
A 33-year-old man with acute pancreatitis and alcohol-induced liver disease presented to the retina department complaining of four days of painless vision loss in both eyes. Both eyes' anterior segment examination and intraocular pressure were normal. Dilated fundus examination of both eyes revealed confluent areas of retinal whitening, hemorrhages, and cotton-wool spots over the posterior pole, indicating Purtscher-like retinopathy. OCT scans through the macula revealed dense inner retinal reflectivity, thickening, and loss of retinal layer stratification, as well as outer retinal layer shadowing and islands of ILM separation, posterior vitreous hyperreflective dots, and minimal subfoveal fluid, all of which corresponded to areas of retinal whitening on fundus photographs. The patient was given a brief course of systemic steroids.
On the tenth day after the presentation, visual acuity in the right eye had improved to 6/18 and finger counting at 1 m in the left eye. The retinal findings had faded. The retina had reverted to its normal thickness on the OCT scans, with minimal hyperreflectivity remaining. The ILM separation and posterior vitreous hyperreflective dots were no longer present.
Following Purtscher or Purtscher-like retinopathy, we believe inflammation could play a major role in the development of these two novel OCT findings. This case offers an additional perspective on the underlying mechanisms responsible for the retinal manifestations observed in Purtscher or Purtscher-like retinopathy.
Purtscher 或类似 Purtscher 样视网膜病变通过眼底检查发现视网膜出血和视网膜变白区域，以及由于前睫状视网膜小动脉的微血管阻塞导致视力下降来诊断。我们在本报告中描述了一例类似 Purtscher 样视网膜病变的新型光学相干断层扫描（OCT）发现，即内界膜（ILM）分离和后高反射点。
一名 33 岁男性，患有急性胰腺炎和酒精性肝病，因双眼无痛性视力丧失四天就诊于视网膜科。双眼前段检查和眼压正常。双眼散瞳眼底检查发现后极部融合的视网膜变白区、出血和棉絮斑，提示类似 Purtscher 样视网膜病变。黄斑 OCT 扫描显示视网膜内层致密高反射、增厚、视网膜层分层丢失，以及外层视网膜层遮蔽和 ILM 分离的岛状结构、后玻璃体高反射点和最小量的中心凹下积液，这些均与眼底照片上的视网膜变白区相对应。患者接受了短暂的全身皮质类固醇治疗。
在发病后第十天，右眼视力提高至 6/18，左眼在 1 米处能数指。视网膜病变已消退。OCT 扫描显示视网膜已恢复正常厚度，仅残留少量高反射。ILM 分离和后玻璃体高反射点已不复存在。
我们认为，在 Purtscher 或类似 Purtscher 样视网膜病变之后，炎症可能在这两种新型 OCT 发现的发展中起主要作用。该病例为 Purtscher 或类似 Purtscher 样视网膜病变中观察到的视网膜表现的潜在机制提供了另一种观点。
