J Korean Ophthalmol Soc.  2018 Apr;59(4):384-387. 10.3341/jkos.2018.59.4.384.

Poor Prognosis in Idiopathic Thrombocytopenic Purpura-associated Retinopathy

• Kwon JM
• Pak KY

• KMID: 2409689
• DOI: http://doi.org/10.3341/jkos.2018.59.4.384

Abstract

PURPOSE
To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis.
CASE SUMMARY
A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient's platelet count was 38,000/µL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient's visual acuity was 0.1 in both eyes, and her platelet count was 7,000/µL. For 2 years, the patient's platelet count was not controlled, and remained between 12,000-19,000/µL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye.
CONCLUSIONS
ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.

Keyword

Immune thrombocytopenic purpura; Roth spot

MeSH Terms

Bevacizumab
Dexamethasone
Diabetes Mellitus
Diabetic Retinopathy
Female
Fingers
Fluorescein Angiography
Hemorrhage
Humans
Hypertension
Light Coagulation
Macular Edema
Middle Aged
Platelet Count
Prognosis*
Purpura, Thrombocytopenic, Idiopathic
Retina
Retinal Hemorrhage
Retinaldehyde
Splenectomy
Triamcinolone
Visual Acuity
Bevacizumab
Dexamethasone
Retinaldehyde
Triamcinolone

Figure

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  Figure 1. Fundus photograph and fluorescein angiography at the initial visit. (A) Fundus photograph at the initial visit shows multiple retinal and subretinal hemorrhages not involving macula. (B) Fluorescein angiography shows microaneurysms at four quadrants of each eye.

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  Figure 2. Fundus photograph and optical coherence tomography after panretinal photocoagulation and intravitreal triamcinolone injection. (A) Fundus photograph at 4 months after panretinal photocoagulation. Retinal and subretinal hemorrhages involving macula and macular hard exudates are noted. (B) Optical coherence tomography shows intra- and sub-retinal fluid and reflective dots in the inner retina. (C) Fundus photograph 1 month after intravitreal triamcinolone injection. Retinal and subretinal hemorrhages are decreased. (D) Optical coherence tomography shows decreased intra- and sub-retinal fluid and foveal pit has been recovered.

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  Figure 3. Fundus photograph at 2 years shows vitreous hemorrhage and massive subretinal hemorrhages in the right eye. Mutiple retinal and subretinal hemorrhages involving the fovea are observed in the left eye.

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