Exudative Retinal Detachment Treatment in a Patient with Thrombotic Thrombocytopenic Purpura

Abstract

Purpose: We report a case of unilateral exudative retinal detachment in a patient with thrombotic thrombocytopenic purpura (TTP), without associated hypertension, successfully treated with plasmapheresis. Case Report: A 46-year-old woman with a medical history of TTP presented with unilateral exudative retinal detachment. Biological and radiological assessment eliminated other causes of exudative retinal detachment, including hypertension. Plasma exchange was performed, followed by a rapid improvement in visual acuity and total disappearance of serous detachment. Conclusion: Exudative unilateral retinal detachment is a rare complication of TTP and can be successfully treated by plasma exchange.

Near-complete vision recovery from bilateral serous retinal detachment associated with thrombotic thrombocytopenic purpura

“…One 46-year-old woman with recurrent TTP presented with sudden vision loss due to unilateral exudative retinal detachment received treatment with PLEX and steroids resulting in improvement in her vision symptoms starting at day 2. 10 Another 32-year-old woman with TTP-associated serous retinal detachment also achieved significant of visual acuity after 6 days of treatment with PLEX and steroids. 19 Another case report noted a young female who developed bilateral serous retinal detachments from TTP that was treated with PLEX and rituximab, with improvement in vision from 20/400 to 20/50 in the span of 16 months.…”

“…Review of case reports for patients with ocular TTP yielded varied treatment strategies and responses. One 46-year-old woman with recurrent TTP presented with sudden vision loss due to unilateral exudative retinal detachment received treatment with PLEX and steroids resulting in improvement in her vision symptoms starting at day 2 10. Another 32-year-old woman with TTP-associated serous retinal detachment also achieved significant of visual acuity after 6 days of treatment with PLEX and steroids 19.…”

“…There are few case reports of bilateral retinal detachment as the initial manifestation of TTP. More commonly, retinal haemorrhages and serous macular degeneration were noted as primary ophthalmologic manifestation of TTP 3 5 7–13. The wide range of reported vision complaints and variable ophthalmologic findings make TTP easy to overlook in the absence of additional systemic manifestations or laboratory evidence.…”

Profound Visual Recovery at 16 Months After Resolution of Serous Retinal Detachments Secondary to Thrombotic Thrombocytopenic Purpura: Case Report and Literature Review

“…Although rare, serous retinal detachments have been well documented in association with TTP and have been reported as an initial, presenting symptom in several reports. [1][2][3][4][5][6][7][8][9][10] We suggest that TTP remains a consideration in the setting of serous retinal detachment in the absence of uveitis because this systemic diagnosis portends a mortality rate of greater than 95% if left untreated. 2 Standard therapy for TTP consists of therapeutic plasma exchange, which aims to remove defective proteins, antibodies, and enzymes from circulation and replace them with fresh frozen plasma.…”

Retinal Arteriolar Occlusions and Exudative Retinal Detachments in Malignant Hypertension: More Than Meets the Eye

“…The choriocapillaris is also supplied by short direct vessels which means that once the rise in arterial pressure overrides the sympathetic tone, the surge in pressure cannot be dissipated in a network of branched arteries as in the retina 10 . To date, ERD had been chiefly reported as a complication of thrombotic thrombocytopenic purpura and preeclampsia [11][12][13] . Our series highlight the fact that idiopathic malignant hypertension (n=5) and glomerular disease (n=1; focal segmental glomerular sclerosis) may also be associated with ERD with (n=3) or without (n=3) concurrent biological signs of thrombotic microangiopathy.…”