J Korean Ophthalmol Soc.  2017 Nov;58(11):1289-1294. 10.3341/jkos.2017.58.11.1289.

Delayed Onset Purtscher's Retinopathy with Serous Retinal Detachment after Trauma in a Retinitis Pigmentosa

• Song H
• Han JS
• Yang JH
• Kim DG

• KMID: 2395872
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1289

Abstract

PURPOSE
To report a case of Purtscher's retinopathy accompanied by serous retinal detachment in a patient with retinitis pigmentosa (RP) who was referred to us for treatment of post-traumatic visual discomfort.
CASE SUMMARY
A 36-year-old man with history of RP was referred to us with the chief complaint of bilateral visual discomfort after chest injury from a traffic accident. His corrected visual acuity was 0.3 and 0.6 in the right and left eyes, respectively. Fundus examination revealed findings characteristic of RP in both eyes, along with a lesion in the right eye, which was suspected to be a serous elevation of the macula, as well as suspected exudates near the optic nerves. Optical coherence tomography indicated serous retinal detachment in the right eye, and fluorescein angiography findings were characteristic of RP. Seven days later, the amount of cotton-wool exudate in the right eye had increased and was more distinct than at the initial examination, and retinal hemorrhage was observed. Based on the medical history and specific fundus findings, the patient was diagnosed with Purtscher's retinopathy. One month later, the serous retinal detachment in the right eye had improved, but the vision loss and total anopsia in the right eye persisted.
CONCLUSIONS
The concomitant occurrence of RP and Purtscher's retinopathy is very rare. Moreover, the presence of accompanying serous retinal detachment and delayed onset of typical clinical symptoms are not present in typical Purtscher's retinopathy.

Keyword

Purtscher's retinopathy; Retinitis pigmentosa; Serous retinal detachment

MeSH Terms

Accidents, Traffic
Adult
Exudates and Transudates
Fluorescein Angiography
Humans
Optic Nerve
Retinal Detachment*
Retinal Hemorrhage
Retinaldehyde*
Retinitis Pigmentosa*
Retinitis*
Thoracic Injuries
Tomography, Optical Coherence
Visual Acuity
Retinaldehyde

Figure

• 

  Figure 1 Fundus photographs of both eyes (A, B) demonstrating peripapillary bone spicule pigmentation, thinning of retinal arteriole. (A, B) Serous elevation of the macula and some exudates around optic disc were found in the right eye. (C) 7 days after trauma, Fundus photograph of right eye shows distinct cotton wool exudate (blue arrow) and retinal hemorrhage around optic nerve (green arrow). (D) 21 days after trauma, Fundus photograph of right eye shows no more white dot.

• 

  Figure 2 Optical coherence tomography (OCT). (A) In initial exam, OCT of right eye shows serous retinal detachment around macula. (B) OCT of left eye shows no serous retinal detachment but overall atrophy of retinal pigment epithelium. (C) 7 days after trauma, OCT of right eye shows decreased subretinal fluid. (D) 21 days after trauma, OCT of right eye shows resolved subretinal fluid but remained wrinkle in the retinal nerve fiber layer.

• 

  Figure 3 Fluorescein angiography of the right (A, B) and left (C, D) eyes. (A, C) Early stage of fluorescein angiography demonstrates extensive window defect due to retinal pigment epithelial atrophy and mid peripheral fluorescein blocking effect caused by bone spicule characteristic for retinitis pigmentosa. Bulll's eye pattern macular appearance due to depigmentation of retinal pigment epithelial layer around macular was seen from early (A, C) to late (B, D) phase.

• 

  Figure 4 Visual field test of both eyes. Visual field test reveal total anopsia in right eye (A) and partially spared low sensitivity central vision in left eye (B).

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