J Korean Ophthalmol Soc.  2013 May;54(5):823-828. 10.3341/jkos.2013.54.5.823.

A Case of Purtscher's Retinopathy with Diffuse Serous Macular Detachment

• Kim YS
• Lee YH

• KMID: 2217054
• DOI: http://doi.org/10.3341/jkos.2013.54.5.823

Abstract

PURPOSE
To report a case of Purtscher's retinopathy with diffuse serous macular detachment.
CASE SUMMARY
A 63-year-old male patient presented to the hospital with decreased visual acuity. Three days prior to visiting the hospital, he had an blunt injury to the thoracic region caused by a steel beam, and his best corrected visual acuity was 20/50 in the right eye and 20/160 in the left eye. On slit lamp examination nothing unusual was observed in either eye, but fundus examinations showed retinal hemorrhages and a cotton wool spots on the posterior pole of the left eye and nothing unusual in the right eye. On fluorescein angiography, severe nonperfusion was observed at the posterior pole of the left eye. On optical coherence tomography, there was diffuse serous retinal detachment at the posterior pole and inferior retina of the left eye while mild subretinal fluid was observed at the posterior pole of the right eye. Under the suspicion of Purtscher's retinopathy in both eyes, oral prednisolone (40 mg) was prescribed and the dosage was gradually reduced. Six weeks after the treatment, best corrected visual acuity improved to 20/20 in the right eye, and 20/30 in the left eye. Additionally, subretinal fluid in the right eye completely disappeared.
CONCLUSIONS
Purtscher's retinopathy is known as an ocular disease occurring after traumatic events. However, serous detachment of the macula has rarely been observed in Purtscher's retinopathy, and herein we report a case with diffuse serous macular detachment which responded to oral steroid treatment.

Keyword

Purtscher's retinopathy; Serous retinal detachment

MeSH Terms

Eye
Fluorescein Angiography
Humans
Male
Prednisolone
Retina
Retinal Detachment
Retinal Hemorrhage
Steel
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Wool
Wounds, Nonpenetrating
Prednisolone
Steel

Figure

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  Figure 1. ( A, B) Fundus photo shows retinal edema and wrinkling of the left eye and no remarkable findings on the right eye. (C, D) On fluorescein angiography (FAG), severe capillary non-perfusion was observed at the posterior pole of the left eye in the early phase. (E, F) late phase FAG showed leakage of fluorescein dye at the non-perfusion areas of the left eye.

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  Figure 2. Optical coherence tomography (OCT) shows hyperreflectivity in the inner retinal layer, retinal folds, cystoid macular edema, and diffuse serous retinal detachment of left eye while mild subfoveal fluid was seen in the right eye.

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  Figure 3. Newly oneset retinal hemorrhage and decreased subretinal fluid were noted in the left eye 1 week after treat-ment (Left) and 3 weeks after treatment (Right), The retinal hemorrhage slightly increased and focal disruptions of the IS/OS junction was seen. However, subretinal fluid, retinal edema, and hyperreflectivity of inner retinal layer con-sistently decreased.

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  Figure 4. Six weeks after treatment. Fundus photo and FAG shows decreased retinal edema and capillary non perfusion areas in the left eye (Left), and no active lesions in the right eye (Right). The subretinal fluid in both eyes deteriorated completely and the IS/OS junction in left eye was more normalized on OCT.

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