Purtscher-like retinopathy following valsalva maneuver effect: case report

Abstract

IntroductionPurtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus, but without an association with trauma.Case presentationA 43-year old Malay man presented with a sudden onset of central foggy vision in the left eye after holding his breath for two minutes while catching a falling object. It was not associated with floaters, flashes of light, or head trauma. His vision in the right eye was 6/6, and in his left eye it was finger counting. He had bilateral temporal sub-conjunctival hemorrhages. An examination of his left fundus revealed multiple white cotton wool spots and dot-blot retinal hemorrhages with diffuse retinal edema at the posterior pole. His right fundus was noted to have only mild temporal peri-papillary edema associated with a few dot-blot hemorrhages. Fundus fluorescein angiography showed good arterial perfusion and no evidence of leaking or neo-vascularization. A diagnosis of Purtscher-like retinopathy was made, and the patient was treated with indomethacin tablets for six weeks. At his six-week follow-up examination, his left eye visual acuity had improved to 6/12. His bilateral sub-conjunctival hemorrhage had resolved. His left fundus showed residual multiple cotton wool spots and reduced retinal edema.ConclusionsTreatment with non-steroidal anti-inflammatory drugs seems to be effective in reducing edema in patients with Purtscher-like retinopathy.

Optical Coherence Tomography Angiography of Purtscher Retinopathy after Severe Traffic Accident in 16-Year-Old Boy

“…The funduscopic findings include whitening of the retina, multiple cotton wool spots, and bleeding of different sizes. The retinal changes are explained by acute ischemia [ 1 , 2 ].…”

Purtscher’s Retinopathy

“…2 There are no specific recommended guide lines for treatment of patients with Purtscher's Retinopathy. Saidin Nor-Mosniwati et al 9 reported a case who was treated with indomethacin tablets 25 mg daily for six weeks and his vision improved from finger counting at presentation to 6/12. Wang et al reported a case of patient who was given a mega dose of steroid that showed a good visual response with in first two weeks of treatment.…”

Purtscher-Like Retinopathy Associated with Synthetic Cannabinoid (Bonzai) Use

“…5 Although there are publications on the use of megadose steroid therapy, hyperbaric oxygen therapy, and oral indomethacin in treatment, they do not provide sufficient evidence for a disease that can be self-limiting. 9 While the benefit of intravitreal bevacizumab was reported in the treatment of macular edema associated with Purtscher-like retinopathy, the complete regression of macular edema at 3 months after injection raised questions about its effectiveness. 10…”