Delineation of capillary dropout in the deep retinal capillary plexus using optical coherence tomography angiography in a patient with Purtscher’s retinopathy exhibiting normal fluorescein angiography findings: a case report

Abstract

BackgroundFat embolism in the deep retinal capillary plexus is one of the reported mechanisms underlying central/paracentral scotoma in patients with Purtscher’s retinopathy. Here we report the clear delineation of capillary dropout in the deep capillary plexus using optical coherence tomography angiography (OCTA) in a chronic case of unexplained scotoma that developed after femoral fracture. The patient exhibited normal fluorescein angiography (FA) findings and a normal retinal appearance.Case presentationA 42-year-old Japanese man with a history of bilateral, unexplained paracentral scotoma that developed after femoral fracture and pulmonary fat embolism due to a car accident 20 years ago was referred to our outpatient clinic. Initial ophthalmological examination revealed unremarkable retinal findings. Goldmann perimetry, FA, and full field electroretinography showed no pathological changes. Although fat embolism in the retinal vasculature was suspected, psychosomatic visual field defects could not be ruled out. We performed OCTA, which clearly delineated capillary dropout in the deep retinal capillary plexus. A final diagnosis of paracentral acute middle maculopathy secondary to Purtscher’s retinopathy was made on the basis of this finding.ConclusionsOur findings suggest that OCTA clearly and noninvasively delineates the deep retinal capillary plexus and the superficial capillary plexus. Because conventional FA provides limited depth resolution, capillary dropout restricted within the deep capillary plexus cannot be detected, particularly when the superficial capillary plexus is well preserved. Thus, OCTA can be a useful tool for the detection of capillary dropout in the deep retinal capillary plexus.

Electric shock induced Purtscher-like retinopathy

“…An interesting finding was noted by Tokimitsu et al . [8] in their report of a 42-year-old Japanese male patient who suffered a femoral fracture. They noted capillary drop-out only in the deep capillary plexus with no changes in the superficial plexus.…”

Assessment of capillary dropout in the superficial retinal capillary plexus by optical coherence tomography angiography in the early stage of diabetic retinopathy

“…The results from the present study showed that the image quality obtained from the OCTA device, RTVue-XR Angiovue, was high and was sufficient for analysis using the built-in image analysis software. This technology has improved the visualization of retinal capillaries and micro-angiopathic features, and offers great potential for the study and quantification of retinal microvascular attributes such as vessel density, branching pattern, capillary tortuosity, vasodilation, microaneurysms, and vascular remodeling in both healthy and diabetic subjects [ 14 – 16 ]. The vessel densities of SCP and DCP were lower in diabetic eyes compared with control eyes [ 17 ].…”

Multimodal Imaging in Purtscher Retinopathy

“…Our findings were consistent with the previous report of a chronic Purtscher retinopathy case. 4 Besides, we also detected the disturbance of macular ellipsoid zone from widefield swept-source optical coherence tomography, which might be associated with a poor visual acuity. In conclusion, optical coherence tomography–based multimodal imaging can be used to visualize capillary nonperfusion, quantify foveal avascular zone, and detect ellipsoid zone defect in acute Purtscher retinopathy.…”