J Korean Ophthalmol Soc.  2008 Mar;49(3):509-513. 10.3341/jkos.2008.49.3.509.

A Case of Purtscher's Retinopathy Responsive to High-dose Steroid Therapy

• Heo J
• Lee YC
• Yang SW
• Kim ST
• Yang PJ

• KMID: 2211327
• DOI: http://doi.org/10.3341/jkos.2008.49.3.509

Abstract

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident.
CASE SUMMARY
A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained.
CONCLUSIONS
In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.

Keyword

High-dose Steroid Therapy; Purtscher's Retinopathy

MeSH Terms

Aged
Capillaries
Eye
Fluorescein
Fluorescein Angiography
Hemorrhage
Humans
Lacerations
Macular Edema
Motorcycles
Porphyrins
Prednisolone
Pupil Disorders
Retinal Hemorrhage
Visual Acuity
Fluorescein
Porphyrins
Prednisolone

Figure

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  Figure 1. At the first visit. (A) A Color photograph of the right eye shows hemorrhages with numerous cotton wool spots in the peripapillary region, superficial intraretinal hemorrhage and macular edema. (B) On fluorescein angiography, capillary nonperfusion and fluorescein filling defects due to numerous cotton-wool spots and retinal hemorrhages were detected in the arteriovenous phase. (C) Fluorescein leakage from macular edema and capillary nonperfusion area was detected in the late venous phase.

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  Figure 2. Seven days after high dose steroid therapy. Fundus photogragh showed that numerous cotton-wool spots, superficial intraretinal hemorrhage, and macular edema were all slightly decreased but still remained and peripapillary hemorrhage was absorbed.

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  Figure 3. Fourteen days after high dose steroid therapy. (A) In fundoscopic findings, peripapillary numerous cotton-wool spots were remarkably decreased and only small amount of retinal hemorrhage was still observed. (B) Fluorescein angiography revealed decreased capillary nonperfusion area in the arteriovenous phase.

Reference

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