Purtscher’s retinopathy is a rare retinal disorder characterized by acute visual loss and retinal findings (cotton-wool spots, intraretinal hemorrhages and retinal whitening) following head or chest trauma. Purtscher-like retinopathy is an acquired form of retinopathy due to hemorrhagic or vasoocclusive vasculopathy associated with acute pancreatitis, renal failure, autoimmune diseases, and thrombotic microangiopathies.
Purtscher Angiopathic Retinopathy; Purtscher-Like Retinopathy.
First described in 1912 by Austrian ophthalmologist, Othmar Purtscher, as a syndrome of sudden blindness associated with severe head trauma. These patients presented with multiple white retinal patches and retinal hemorrhages associated with severe vision loss.
Very rare, estimated incidence of 0.24 per 1,000,000 patients per annum.
Acquired disease. Associated underlying diseases may have genetic component.
Purtscher retinopathy is diagnosed when at least three of the five following criteria are fulfilled: Purtscher flecken, 1 to 10 retinal hemorrhages, cotton-wool spots, probable or plausible explanatory etiology, and complementary investigation compatible with the diagnosis.
The clinical findings have traditionally been associated with severe crush injuries. However, Purtscher-like retinopathy has also been reported in association with pancreatitis, thrombocytopenic purpura, Hemolytic Uremic Syndrome, systemic lupus erythematosus, dermatomyositis, scleroderma, and amniotic fluid embolism. The ophthalmoscopic findings associated with this syndrome are peripapillary cotton-wool spots, intraretinal hemorrhages, asymmetrical venous engorgement, and retinal whitening. The circumstances in which Purtscher retinopathy develops determine the clinical picture.
The anesthetic management needs to take into consideration the different causes of the underlying pathology. To avoid sudden increases in intraocular pressure, medication susceptible to affect it such as succinylcholine and ketamine should be avoided if possible. Moderate hyperventilation can contribute to reduce intraocular pressure.
et al: Purtscher-like retinopathy associated with atypical hemolytic uremic syndrome. Turk J Ophthalmol